Compliance Specialist
3 weeks ago
At Medical Transportation Management Inc., we are seeking a highly skilled Compliance Coordinator to join our team. The Compliance Coordinator plays a vital role in ensuring our company's overall contractual compliance by partnering with various departments to develop and implement long-term compliance solutions.
Key Responsibilities:
- Monitor potential Fraud, Waste, and Abuse (FWA) by performing investigations, facilitating member appeals and transportation provider appeals, and overseeing the performance improvement plan (PIP) process for transportation providers.
- Act as a liaison and provide support to auditors as they review operational processes, policies and procedures, and contract management functions.
- Help oversee Quality Improvement Plans, audits, provider assessment reviews, and assesses liquidated damages.
- Create contractual compliance monitoring tools and matrixes to ensure compliance metrics are sustained, follow best practices, and ensure all validation and quality requirements are met and documented.
- Utilize large datasets to identify potential compliance deficiencies and monitor and maintain audits to reduce or define deficiencies.
- Develop project plans, tracking and trending mechanisms to correct any identified deficiencies as well as identify focus areas for improvement to strengthen MTMs Compliance Program.
- Read, comprehend, and apply contract document requirements, including application of contract verbiage and requirements for the operational processes of the organization.
- Ownership and creation of PIPs for transportation providers by monitoring the dissemination of PIPs to transportation providers, including the progress made by transportation providers while actively on PIPs.
- Facilitate internal audits including, conduct process reviews, conduct transportation provider focus audits, and document and report audit findings.
- Own quality improvement plans and monitor progress to ensure compliance is achieved.
- Communicate information to Quality and Compliance Committee, Department heads and Executive Leadership; Monitor operational SLAs for Executive Leadership Team and identify risks for consideration.
- Manage net promoter scores and satisfaction surveys for internal and external clients.
- Provide recommendations for systematic internal controls and process changes to ensure ongoing compliance for corrected deficiencies; includes assisting in implementation of remediation to address compliance concerns.
- Proactively identify, prevent, and report potential FWA to Leadership and external clients, make determinations for cases involving fraud, appeals, denials and LDs, and make recommendations for improvement based on findings.
- Facilitate the pre-assessment and liquidated damage process by investigating an making determinations to pre-assessment review requests and liquidated damage appeals using contractual documents to determine accuracy.
- Manage and/or assist with other internal and external special projects and tasks as needed.
Requirements:
- Bachelors Degree or equivalent relevant experience.
- Detail-oriented, thorough, and systematic/methodical approach to projects.
- Strong project management and organizational skills.
- Basic to intermediate understanding of data base/system concepts and/or design.
- Ability to complete basic to intermediate data analysis and trending.
- Proficient in Microsoft applications (Word, Excel, Outlook, PowerPoint and SharePoint).
- Previous experience in contract compliance and/or operational auditing role preferred.
- Basic understanding of SQL and/or XML preferred.
Benefits:
- Dental and Vision Plans.
- Paid Time Off and Holiday Pay.
- Casual Dress Environment.
- Tuition Reimbursement.
MTM considers qualified candidates with a criminal history in a manner consistent with the requirements of applicable local, State, and Federal law.
Equal Opportunity Employer - minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity
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