Senior Vendor Compliance Analyst
Company: MetroPlus Health Plan
Location: Jersey City
Posted on: January 15, 2022
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
- Conduct annual assessment of our delegated vendor oversight
- 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
- Bachelor's Degree in a health-related field, Master 's Degree
- 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
- 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
CompetencieProfeional CompetenciesProfessional Competencies
Keywords: MetroPlus Health Plan, Jersey City , Senior Vendor Compliance Analyst, Professions , Jersey City, New Jersey
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