Compliance Manager

TRESA STAFFING is seeking a season Compliance Manager who is an expert in contracts interpretation and can provide directory oversight, and audit for CMS and DOI. Will be the primary point of contact for CMS, NCQA and DOI audits and requirements. Must effectively and accurately administrate contract and provider data. Responsible for the data integrity of contract and provider data entered into all systems and verification of provider directories.
The Compliance Manager will be the person to giveGeo-Access reports for CMS and State GA.
Responsibility:
Develop and maintain organization policies and procedures; Representation at all national, regional and internal audits;
Serve as the primary liaison between Compliance department and Provider Contracting, as well as other departments during preparation for audits; develop and conduct audits / monitoring processes within the department;
Serve as Compliance trainer for the department.
Responsible for collaborating with other departments that require contract and provider data to ensure efficient workflow processes for the region notifications. In addition; position will be required to serve as the department manager for assigned projects and prepare and develop monthly and special reports.
Will be the primary point of contact for CMS, NCQA and DOI audits and requirements.
Responsibility:
Compliance obligations are including but not limited to development and maintenance of the department's policies and procedures; representation at all national, regional and internal audits; serve as primary liaison between Compliance department and Provider Contracting, as well as other departments during preparation for audits; develop and conduct audits / monitoring processes within department; serve as Compliance trainer for department.
Essential Responsibilities:

  • Quarterly provider directory audits per CMS and State of GA requirements; make sure KPGA is in compliance.
  • Represent Provider Contracting at all audits: National (CMS, NCQA, DOI National Compliance), Regional (Internal Audit, External Auditors). Preparation of all documentation required by audits. Meet with auditors and regulators during audits to assist their review and present required information.
  • Run Geo-Access Queries and provide results to management for review and action.
  • Accurate financial, contractual and demographic data for contracted hospitals, ancillary and physician providers.
  • Responsible for department meeting compliance standards for internal and external entities.
  • Compliance oversight within the department (in accordance with National, Regional, SOX and departmental guidelines).
  • Compliance trainer for Department.
  • Complete annual Risk Assessments and Compliance Summary

Basic Qualifications:

  • Minimum three (3) years of prior Provider Relations, Contracting, Claims or other HMO systems work.Education
  • Bachelor's degree required.License, Certification, Registration
  • N/A. Additional Requirements:
  • Compliance and Audit experience.
  • Strong ability to analyze data, complex contract terms & understand auditing processes.
  • Excellent organizational and prioritization skills, the ability to work under tight deadlines, high productivity are required.
  • Strong written and communication skills required.
  • Expert knowledge of Excel, Access, Word, PowerPoint.
  • Preferred Qualifications:
  • Master's degree preferred.
  • Project Management Certification.
  • Compliance Certification.

Is Relocation Available?Yes, nationwide
What are the 3-4 non-negotiable requirements on this position?Experience Minimum three (3) years of prior Provider Relations, Contracting, Claims or other HMO systems work.
Compliance and Audit experience.
Education Bachelor's degree required.

Job Type: Full-time

Experience:

  • HMO System: 3 years (Required)
  • Compliance: 3 years (Required)
Company
TRESA Agency
Posted
11/06/2021
Salary Range
$54,000.00 - 100,000.00
per Year
Salary range estimated by
Location
Atlanta, GA 30383, US
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