Will coordinate the compliance monitoring and auditing functions necessary to meet the regulatory requirements established by the Centers for Medicare and Medicaid Services (CMS).
As part of Peoples Health's Compliance Program, Oversight Coordinators are liaisons to specific departments and first tier, down stream and related entities (FDRs). This position is responsible for all compliance monitoring and auditing functions related to CMS regulatory guidelines and requirements for Peoples Health Networks and its FDRs.
- Review all regulatory communications applicable to the organization
- Monitor implementation of changes to CMS regulatory guidelines
- Coordinate and perform ongoing internal monitoring for operational areas, including tracking compliance and implementing appropriate action as required
- Audit operational areas in accordance with annual work-plan and at the direction of Compliance Department management to determine compliance with requirements, including validation of data and internal controls
- Manage the issuance and follow-up of compliance actions initiated in response to identified issues
- Coordinate the timely and accurate completion of CMS Reporting Requirements and other required CMS submissions
- Perform appropriate CMS data submission quality checks and update developed tools as necessary
- Monitor, analyze and communicate CMS Analyses Reports
- Coordinate and assist the Compliance Officer in preparation activities for regulatory site visits and reviews
Bachelors degree preferred and/or a minimum of 3 years work experience in the managed care industry, preferably in a Medicare Advantage Plan. Strong computer skills including proficiency in word processing, spreadsheet and data base management skills required. Ability to manage multiple tasks simultaneously and work independently. Excellent oral and verbal communication skills and interpersonal skills are a must. Candidate should be detail oriented with the ability to meet deadlines. Professionalism is a must.