Manager, Compliance FDR Oversight – Hybrid #22-81

13 Sep, 2022

Jobs

Manager, Compliance FDR Oversight – Hybrid #22-81

Commonwealth Care Alliance
Boston, MA
Why This Role is Important to Us

Under direction of the Director of Regulatory Compliance, the primary focus areas of this position include development and oversight of an enhanced First Tier, Downstream and Related Entity (FDR) Program; develop and oversee CCA’s Compliance Research Program; Oversee and manage compliance and business unit program monitoring metrics; and oversee CAP process for identified instances of non-compliance.

What We’re Looking For
Education Required:
  • Bachelor’s Degree or equivalent experience
Education Desired:
  • Master’s degree in health care administration, public administration, public health, political science, American history, or business administration
Experience Required:
  • 5 or more years direct work experience in regulatory affairs and/or compliance
  • 5 or more years of managerial experience is required.
  • Health care industry experience required.
  • Project management skills or equivalent are required.
Knowledge, Skills & Abilities Required:
  • Strong written, verbal, listening and communication skills — having the ability to understand and communicate appropriately to the targeted audience
  • Strong supervisory/managerial skills. Manage staff workload appropriately and identify areas of improvement and areas for professional development for staff
  • Strong analytical skills — having the ability to identify an issue, conduct an analysis to determine business impact (including gap analyses), troubleshoot
  • Strong project management skills – having the ability to effectively manage multiple priorities simultaneously by maintaining established timeframes, adhering to work plans, and communicating changes effectively
  • Strategic thinking and planning in order to continue to enhance the Compliance Program and the role of compliance within the organization: ability to initiate and develop new solutions to problems, to identify new opportunities; and have organizational perspective to see how the pieces fit and reflect that perspective in day-to-day decisions
  • Ability to influence team members and
  • owners to resolve issues in a timely manner
  • Requires diplomatic and negotiation skills and understanding of needs of internal and external partners
  • Ability to work independently
  • Ability to present information clearly in meetings and to communicate with team members and senior leadership
  • Requires excellent interpersonal skills in order to communicate and work with staff of all skill and experience levels
  • Self-directed with proven initiation skills
  • Must be able to effectively communicate with colleagues, internal customers, and vendors
Other:
  • Position requires constant operation of a computer and other office equipment (i.e., copy machine, Polycom equipment, and computer printer)
  • Must be able to remain in a stationary position 50 percent of the time
Actual Work Location
30 Winter Place, Boston, Massachusetts 02108
All Locations
30 Winter Street; HYBRID
Exempt / Not Exempt
Exempt
What You’ll Be Doing

FDR Oversight

  • Develop Annual FDR Risk Assessment and refer a subset of FDR vendors to Internal Audit annually
  • Maintain compliance attestations for vendors appropriate to category of risk.
  • Represent Compliance at Joint Oversight Committees, as directed.
  • Intake compliance issues reported by vendor business owner or Vendor Management department and determine triage, actions, and escalation
  • Review RFP and RFIP and determine categories of compliance relevant to proposed services
  • Review RFP documentation submitted by vendors and make determination of adequacy/risk, consulting department subject matter experts, as needed.
  • Coordinate pre-implementation audit or review
  • Identify and monitor compliance metrics related to vendor service level agreements.
  • Educate business owners about their role in overseeing vendor’s compliance with CCA regulatory obligations
  • Identify and monitor with business unit metrics according to Medicare and Medicaid requirements
  • Monitor for compliance with applicable regulatory requirements and standards relative to the Medicare and Medicaid programs. This individual is responsible for reviewing and monitoring FDR and internal business unit oversight in such a way that ensures that all Medicare and Medicaid regulatory requirements and standards are understood, business processes required to address those regulations and standards are implemented and any compliance risks are communicated to the Director.
  • This individual must maintain open lines of communications with internal departments and vendors to ensure timely response to compliance issues and to promote the enterprise-wide culture of compliance. This will support the implementation of new CMS guidance relating to the assigned FDRs; performing ongoing monitoring of critical processes; and working with business owners to ensure timely and appropriate closure of any identified issues.
  • Conduct site visits of potential and current vendors, as required
  • Responsible for oversight of polices, SOPs and job aides related to compliance and FDR functions

Oversight of CCA’s Compliance research program

  • Act as primary contact for incoming compliance research requests
  • Distribute research requests to team staff based on level of research complexity
  • Review research results to ensure accuracy
  • Develop and maintain training and research documentation and instructions and provide training as required
  • Support business units in interpretation of regulations related to their applicable areas as well as aid in developing appropriate tools to ensure compliance

Compliance Program Metrics

  • Oversee the development of metrics and reporting to demonstrate effectiveness of CCA’s Compliance Program.

Manage staff who will:

  • Identify, develop and product metrics to demonstrate effectiveness of CCA’s Compliance Program.
  • Work collaboratively with all divisions within Compliance Department
  • Prepare metrics and reports for consumption by different levels within the
  • Review certain issue notifications/disclosures and assign compliance risk level.
  • Work collaboratively with impacted departments to identify root cause and make recommendations for corrective actions, as identified.
  • Process all MassHealth Rate, Federal Register and OIG notifications. Create summaries of changes to requirements and regulations, and independently identify business owners, impacted departments, and required next steps for implementation.
  • Review, analyze and distribute Annual OIG Workplan

Learn more here

Job posted: 2022-09-13