Overview:
Oversees compliance and regulatory functions to ensure VNS Health's managed care products are in accordance with applicable federal and New York State laws, regulations, and contractual requirements. Serves as a subject matter expert in managed care regulations, collaborates with internal departments to promote a strong culture of compliance, and liaises with applicable state and federal agencies on regulatory matters. The Manager has a deep understanding of healthcare compliance, regulatory frameworks, and risk management and possesses strong leadership and interpersonal skills, with the ability to influence and guide cross-functional teams. This individual works under general supervision. Assigned portfolio includes VNS Health's Medicare Advantage products (i.e., MA-PD, D-SNP, FIDE SNP), with an emphasis on federal Medicare requirements. Serves as the subject matter expert in Medicare Compliance regulations, liaises with CMS on regulatory matters, and has a deep understanding of Medicare compliance, including Program Audit experience.
Responsibilities:
What We Provide
- Referral bonus opportunities
- Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
- Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
- Employer-matched retirement saving funds
- Personal and financial wellness programs
- Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
- Generous tuition reimbursement for qualifying degrees
- Opportunities for professional growth and career advancement
- Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
This role requires an on-site presence in New York three days per week
What You Will Do:
- Serves as Project Manager for regulatory affairs projects related to new or updated regulatory guidance. Acts as the liaison with business areas to ensure appropriate changes are made to the impacted departments. Develops monitoring processes to ensure implementation is effective and compliant.
- Provides guidance to lines of business on compliance risks, ensuring operational readiness and adherence. Ensures that communications regarding high-impact regulatory changes are provided to key operational and shared services stakeholders. Develops and provides training and education on new or updated regulatory requirements to Compliance and operations, as applicable.
- Manages regulatory filings, submissions, and reporting obligations, including oversight of corrective action plans (CAPs), routine compliance reports, and required attestations. Manages the process for the issuance, development, remediation, and validation of regulator-issued CAPs for identified and/or reported issues of non-compliance.
- Assists in the review, development, revision and maintenance of compliance policies and procedures.
- Assists in the preparation of updates and reports to management, Board of Directors, and Compliance Committee related to regulatory affairs and related compliance activities.
- Ensures compliance with requirements established by applicable federal and state regulatory bodies and other bodies overseeing managed care organizations.
- Monitors and interprets applicable federal and New York State statutes, regulations, and guidance affecting managed care organizations. Assesses the impact of applicable regulatory changes on the enterprise's programs and health insurance plans.
- Develops and maintains tracking related to external audits, corrective action plans, attestations, etc.
- Assists with the annual risk assessment and development of the auditing and monitoring plan.
- Ensures compliance with requirements established by the Centers for Medicare & Medicaid Services (CMS).
- Monitors and interprets applicable federal regulations and guidance affecting MAPD plans. Assesses the impact of Federal regulatory changes on the enterprise's programs and health insurance plans.
- For compliance and regulatory affairs projects, develops auditing and monitoring processes to ensure implementation is effective and compliant.
- Communicates with the Plan's CMS account manager regarding disclosures and general inquiries.
Qualifications:
Licenses and Certifications:
Compliance related certification preferred
Education:
Bachelor's degree in business, Health Care Administration, or a related discipline required
Master's Degree preferred
Work Experience:
- Minimum of four years of experience working in the health care industry, preferably with healthcare compliance, regulatory affairs, or managed care operations, with at least 3 years in a leadership or management role Required
- Demonstrated ability to research and interpret complex managed care regulations and communicate requirements effectively to operational teams Required
- Proven capacity to work collaboratively across departments and build strong compliance partnerships Required
- Exceptional ability organizational, analytical, time management, project management and problem-solving skills Required
- Excellent written and verbal communication skills Required
- Fluent in Word, Excel, and Power Point Strong knowledge of Medicare regulations and compliance requirements Required
Pay Range:
USD $109,900.00 - USD $146,500.00 /Yr.