Summary

Provide technical, operational, and administrative support to the Network Compliance Manager to execute network compliance operational duties and responsibilities within the Network Management and Population Health department. Lead and implement Provider Network initiatives and other ad-hoc projects. Serve as liaison between vendors and other internal stakeholders to ensure that Directory Production deliverables are met
within established regulatory timeframes. Perform regulatory related functions: handle inquiries and communications with regulatory agencies; participate in the development and implementation of departmental initiatives; coordinate internal and external audits impacting the dept. Responsible for the management of all departmental Operational Processes (OP).

Responsibilities:

Network Compliance

• Perform regulatory tasks to include but not limited to reviewing PNDS Deficiency Tracker responses for accuracy and completeness.

• Coordinating deliverables for internal/external audits.

• Handle regulatory communications; coordinating with Network Management staff and others as necessary to develop responses to inquiries.

Directory Production Process

• Ensure the timely request/receipt of directory files.

• Develop the necessary business requirements for directory production and liaise with the directory production vendor to ensure all requirements are programmed and developed.

• Effectively manage the directory productive schedule to ensure deliverables are on track; identify potential bottlenecks to compliance with due dates and escalating to management when necessary.

Lead Adhoc Projects

• Identify project stakeholders and conduct meetings to define roles and responsibilities, hold parties accountable, keep projects on schedule and raise issues to senior management where necessary.

• Collaborate with IT, external vendors and internal business stakeholders on project scope, requirements, testing and implementation where appropriate.

• Report on project status to senior management as requested - Operational Processes (OP): Annual Monitoring, Development, and Implementation.

• Work with business owners to review OPs annually, update when necessary, and present at the monthly meeting.

• Schedule and facilitate monthly OP presentation meetings.

• Maintain and monitor log of all approved OPs to ensure annual review of all processes under Network Management and Population Health.

Qualifications:

• Bachelor's Degree

• 4 - 6 years of relevant work experience, preferably with a healthcare provider (R)

• Additional years of relevant experience may be considered in lieu of educational requirements (R)

• Knowledge of managed care/regulatory requirements (R)

• Ability to: effectively multitask; manage a high volume of work; ensure regulatory deadlines are met (R)

• Ability to review regulatory inquiries, interpret requests and draft appropriate responses (R)

• Excellent communications skills (verbal, written, presentation); and the ability to effectively facilitate/control meetings (R)

• Proficient in Word, Excel, and Outlook; knowledge of Adobe Acrobat, Nuance Converter, Tagging (508 Compliance) (R)

• Experience with managing/leading projects (R)

• Must be able to: work independently and show initiative; and work collaboratively with others and build positive relationships internally and externally (R)

• Attention to detail in order to identify discrepancies when reviewing large documents and spreadsheets (R)

• Ability to use good judgment in decision making and maintain professionalism at all times (R)

Additional Information

• Requisition ID: 1000000425