Compliance and Quality Assurance Expert

6 days ago


Brooklyn, New York, United States MetroPlus Full time

At MetroPlusHealth, we are committed to empowering New Yorkers by uniting communities through care. As a Sales Quality and Compliance Specialist, you will play a critical role in ensuring that our sales department adheres to regulatory and contractual requirements for various lines of business.

Job Summary

The Sales Quality and Compliance Specialist reports directly to the Chief Growth Officer and is responsible for conducting ongoing monitoring activities to ensure compliance with regulatory requirements. This includes supporting the development and review of sales department policies and procedures, conducting audits, and providing training on compliance-related matters.

Key Responsibilities
  • Support the development and review of sales department policies and procedures to ensure compliance with regulatory requirements.
  • Conduct audits to ensure adherence to policies and procedures, including field observations and analysis of data.
  • Provide training on compliance-related matters to sales personnel.
  • Analyze data to identify trends and areas requiring corrective action.
  • Collaborate with cross-functional teams to ensure compliance objectives are met.
Requirements

To be successful in this role, you will need:

  • A Bachelor's degree required.
  • At least 4 years of managed care experience, including thorough knowledge of Medicare, federal, and state regulations.
  • Prior experience in quality improvement and compliance oversight.
  • 1-3 years of Compliance/Regulatory Affairs experience.
  • Project Management experience.
  • Strong computer skills, including Excel, Word, PowerPoint, and MS Project.
  • Excellent Business Writing Skills.
  • Cross-functional interdepartmental skills.
About MetroPlusHealth

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens, and Staten Island through a comprehensive list of products, including Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, and more. We are committed to building strong relationships with our members and providers to enable New Yorkers to live their healthiest lives.

Estimated Salary Range

$80,000 - $110,000 per year, depending on experience.



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