Compliance - Coordinator 2
Found in: beBee S US - 1 week ago
Department
Compliance Operations
Job Summary
Job Description
Acts as lead for all Dental Prepaid Ambulatory Health Plans (PAHP) relative to member denial notices.
Acts as primary contact for all Dental PAHP issues relative to denial notices of prior authorized dental services.
Effectively monitors and tracks changes to section 42 of the code of federal regulations (42 CFR) and rulemaking relative to Dental PAHP to identify potential impacts to the Legal Compliance auditing and review process.
Creates and reviews internal reports to ensure all dental PAHP activities and projects remain on schedule and are completed within the required timelines and submitted to the Legal Compliance manager for review.
Proactively organizes dental PAHP meetings, compiles meeting notes for distribution and tracks action items for follow-up and completion.
Responsible for initiating onboarding and ongoing monitoring of all dental PAHPs.
Acts as the Dental PAHP subject matter expert.
Identifies training opportunities with internal and external stakeholders.
Develops and manages Dental PAHP related training content of educational materials, dental specific denial notice templates, and desk manuals relative.
Supports the Program Manager with delivery of all Dental PAHP trainings.
Ensures that Dental PAHP member denial notices comply with federal, state, and contract requirements and are developed in accordance with established best practices, including in the spirit of the prior Wells v. Gee court mandate.
Tracks and responds to all inquiries from the dental PAHPs timely and escalates to the Program Manager, when needed.
Assists with ensuring all assigned Managed Care organizations (MCOs) are in compliance with the state contract, and all applicable federal and state laws, rules and regulations, and established through the monitoring and tracking mechanisms developed for legal compliance. Includes working directly with MCOs, contractors, and LDH Waiver and Behavioral Health agencies as needed; conducting mandatory recipient notice reviews; and reviewing/formulating corrective action plans, reports, and relative documentation as deemed appropriate.
Reviews assigned contractor deliverables for accuracy and completeness.
Assists with designing and maintaining internal reports to ensure all monitoring activities remain on schedule and are completed within the required timelines.
Conducts and participates in meetings, workgroups, public meetings, and other activities as directed.
Records, prepares, and distributes meeting minutes and action items for assigned contractors, including dental PAHPs
Assists the manager with maintaining updates to policies, procedures, and training manuals.
Plans, coordinates, and executes communications related to compliance; includes written and verbal communications and communications with both internal and external stakeholders.
Develops and manages all denial template revisions and template examples for MCOs, dental PAHPs and other contractors, as applicable.
Acts as backup for the development and revisions to the Legal Compliance tasks calendar.
Assists as backup for the internal Legal Compliance monthly metrics report.
Takes the lead for reviewing, organizing, and coordinating LDH responses to requests from Disability Rights Louisiana with Program Manager’s approval.
Assists with the development and dissemination of Legal Compliance bulletins.
Participates in the training of new staff.
Assists with other projects as needed and performs additional duties as assigned.
QUALIFICATIONS
REQUIRED:
Bachelor’s degree or six years of professional work experience in lieu of degree.
Minimum 1 year of professional experience working with federal/state healthcare programs, Medicaid Support, or related field.
Proficient in the use of Adobe Acrobat Pro as well as Microsoft Office Suite (Word, Excel, PowerPoint, and Outlook).
Strong analytical abilities, effective organizational and time management skills.
Great attention to detail and follow up, and verbal/written communications skills.
Works well both independently and as part of a team.
Ability to set, follow, and meet deadlines.
DESIRED:
Advanced degree.
Minimum two years of experience working with federal/state/healthcare programs, Medicaid support, or related field.
Minimum two years of professional experience with compliance and/or project management activity.
Minimum one year of professional experience reviewing and editing written content for accuracy, and general proofing.
Industry-related certifications.
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