Senior Corporate Compliance Analyst

Company: MetroPlus Health Plan
Location: Jersey City
Posted on: May 11, 2022

Job Description:

Empower. Unite. Care.MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.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 OverviewThe Senior Corporate Compliance Analyst reports to the Director of Corporate Compliance and Privacy. The Senior Corporate Compliance Specialist will support the oversight and management of Corporate Compliance activities, including assisting in the review of department policies, investigating reports of non-compliance, addressing and tracking inquires, responding to all corporate compliance related questions, monitoring and auditing business areas, supporting the organization with corrective actions and contributing to the annual compliance risk analysis and work plan. - Ensuring the Corporate Compliance related trainings are accurate and up to date. -Job Description

• Assist the Director of Corporate Compliance and Privacy in the development of the annual risk assessment and implementation of the annual work plan.
• Manage ongoing monitoring activities and develop and execute audits as identified in the annual compliance work plan.
• Responsible for the initial screening, timely investigation, and triaging of compliance matters. Ensuring a thorough and comprehensive investigation of the alleged compliance violation is performed, including data gathering, analyses, interviews, and issuing a final report. Essential to this role is the ability to track and trend emerging issues and work with the Director to develop a respond on an organizational level for systemic issues.
• Respond to questions and concerns relating to general corporate compliance matters, including exclusion screening, fraud, waste and abuse concerns, institutional gift policy, etc. 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.
• 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 various committees in which Corporate Compliance participates, including the Fraud, Waste and Abuse Committee, Compliance Committee, and Audit and Compliance Committee of the Board of Directors.
• Assist in managing our relationship with the Special Investigations Unit, including: active participation in monthly meetings, ensuring ongoing collaboration, and identifying opportunities for improvement.
• Monitoring ongoing exclusion screening processes. Ensuring all responsible business units are conducting the necessary screenings on a monthly basis.
• Responsible for ensuring P&Ps related to Corporate Compliance are reviewed and updated on an annual basis and as regulatory changes occur.
• Conduct an annual assessment of our corporate compliance program.
• Must remain abreast of emerging topics and issues impacting corporate compliance on the State and Federal level. If any changes impact the organization, must be able to work across departments to ensure proper implementation. -
• Support the Director of Corporate Compliance and Privacy with any required regulatory reporting.
• Other duties as assigned or requestedMinimum Qualifications
  • A Bachelor's degree required.
  • 5 or more years of Managed Care experience.
  • 3-5 years' experience in a compliance, privacy, regulatory affairs, or government affairs function within a Managed Care Organization, preferred.
  • Strong knowledge of the requirements and processes on agencies such as DOH and OMIG
  • Prior successful experience working with regulators on compliance audits, reporting and other matters.
  • Experience managing complicated projects, keeping track of details, and staging work to deliver projects on time.
  • 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.
    • Knowing the processes and requirements of regulators (DOH, OMIG, etc.)
    • 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 Competencies

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