Senior Corporate Compliance Analyst
Company: MetroPlus Health Plan
Location: Jersey City
Posted on: May 11, 2022
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
- 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
- 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
- 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
- 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
- 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
- Experience with developing reporting and metric.Professional
- 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,
- 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
- 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
- The utmost integrity in the discreet and confidential handling
of confidential materials is necessary.Professional
Keywords: MetroPlus Health Plan, Jersey City , Senior Corporate Compliance Analyst, Professions , Jersey City, New Jersey
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