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Senior Vendor Compliance Analyst

Company: MetroPlus Health Plan
Location: Jersey City
Posted on: January 15, 2022

Job Description:

About NYC Health + HospitalsMetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus ' network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. -Position OverviewReporting to the Director of Corporate Compliance and Privacy, the Sr. Vendor Compliance Analyst is the designated resource for MetroPlus ' Vendor Compliance Program. Working with the Plan 's Subject Matter Experts (SMEs), this individual will assist the Director in providing oversight of MetroPlus ' First Tier, Downstream and Related Entities (FDRs) and other vendors that perform administrative and health care service functions on behalf of the Plan to ensure compliance with all contractual and regulatory obligations. This individual is also responsible for identifying and tracking potential operational risks posed by a vendor 's activity.Job Description

  • Assists in the performance of risk assessments for each delegated entity, and ensures reporting, monitoring, and audits capture the review of the risks identified.
  • Work with Regulatory Compliance to ensure any implementations impacting our vendors are appropriately completed. This include disseminating guidance and gathering necessary documentation.
  • Manage ongoing monitoring activities and executing audits as identified in the annual compliance work plan.
  • Respond to questions and concerns relating to vendor compliance requirements with internal parties.
  • Develop, issue, and monitor corrective action plans as issues arise from ongoing monitoring and auditing activities. Must be able to track, trend and escalate matters as needed.
  • Ensure vendor managers are kept abreast of compliance related issues. Work with Vendor Management on an ongoing basis.
  • Creating, reviewing, and submitting internal and external reports as required. Will need to engage with leadership from various areas and vendors to compile information needed for response. - Includes data submitted for the Vendor Delegation Oversight Subcommittee (VDOS), Compliance Committee, and Audit and Compliance Committee of the Board of Directors. For the VDOS, this individual is responsible for obtaining and reviewing vendor reports and identifying issues.
  • Ensure business areas are conducting ongoing monitoring of delegated functions by reviewing monthly reports sent to business areas for compliance risks. Business areas should be submitting a monthly assessment of the vendor's performance. Any compliance issues must be investigated and escalated where necessary.
  • Responsible for ensuring P&Ps related to Vendor Compliance are reviewed and updated on an annual basis and as regulatory changes occur.
  • Conduct annual assessment of our delegated vendor oversight program.
  • Participates in strategic planning of delegation activities, as well as initiative to improve quality and service provided by Vendors. - May lead work teams, work groups and committee discussions to address specific delegation standards requiring focused attention. -
  • articipates in annual and ongoing audits of delegated entities. Audits include a review of related policies and procedures, review of downstream oversight, and compliance with regulatory and plan requirements. Responsible for the issuance of final audit report, along with any corrective action plans needed.Minimum Qualifications
    • Bachelor's Degree in a health-related field, Master 's Degree preferred.
    • Three (3) or more years of profession experience in a compliance, regulatory affairs, or government affairs function within a Managed Care Organization, preferred.
    • Prior successful experience working with regulators on compliance audits, reporting and other matters.
    • Knowledge of managed care regulations and health insurance laws, especially in relation to vendor oversight.
    • Experience organizing, coordinating, and participating in FDR monitoring and auditing.
    • Proven ability to articulate regulatory requirements to business and technical staff to capture information and achieve results.
    • Experience with developing reporting and metric.Professional Competencies - - - -Solid Microsoft Excel skills and strong proficiency using MS Word, PowerPoint, and SharePoint. - - - -Broad-based in-depth knowledge of the managed care industry, including: strategic compliance planning, regulatory concerns, compliance requirements, and corporate integrity principles. - - - -The ability to comprehend and interpret regulatory, legislative, and contractual mandates. - - - -Experience working with regulators on compliance audits, reporting and other matters. - - - -Experience with managed care, Medicaid and federal regulations, quality improvement and compliance oversight. - - - -High-level of skill in leading interdepartmental and cross-functional projects; experience managing. professional staff on multiple projects to ensure corporate deadlines and objectives are met. - - - -Excellent oral, written, and presentation skills, state as well as conceptual and analytic skills are necessary to review and articulate corporate objectives and Federal regulations across all relevant audiences. - - - -The utmost integrity in the discreet and confidential handling of confidential materials is necessary.Professional CompetenciesProfessional CompetencieProfeional CompetenciesProfessional Competencies

Keywords: MetroPlus Health Plan, Jersey City , Senior Vendor Compliance Analyst, Professions , Jersey City, New Jersey

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