• Previous
  • Next
16Apr

Manager of Contracts & Compliance

Medical Associates, Dubuque, IA

This listing has expired

Medical Associates Clinic & Health Plans as an exceptional opportunity for you to join our growing team as a Manager of Contracts & Compliance. 

Role:

Manage and lead provider contracting, compliance and credentialing functions and staff.  Oversee efforts and partnerships to achieve compliance, quality and cost management objectives.

Major Duties and Responsibilities:

Contract Management and Compliance
• Develop and maintain process, systems and explicit measures that ensure timely and accurate execution of contracting and compliance objectives.
• Carry out assessment of healthcare compliance and contracting policies and procedure and assist in updating or developing new policies to enhance operations or/and internal controls or to consider new policies and procedures. 

Provider Contracting
• Responsible for annual process and review of network contracting strategy which includes establishing a plan for each major contracting entity or Network region.
• Monitor local market trends relative to provider contracting and reimbursement, make recommendations to modify current processes and lead or assist with implementing changes as necessary.
• Manage the implementation of reimbursement strategies by utilizing reports, reimbursement summary documents and industry information
• Oversee the provider credentialing and recredentialing process in accordance with NCQA, Medicare and Company policy.

Regulatory Monitoring
• Be informed of current legislation and enforcement issues affecting the healthcare industry, including Medicare Cost Plan requirements, Medicare Advantage requirements, Clinical Quality Programs impacting Physicians, such as MACRA or MIPS or their successors, as well as compliance best practices.

Risk Management
• Carry out risk analysis on healthcare compliance, discover areas of potential compliance risk and vulnerability, and create and implement solutions to eliminate the potential risks.  Coordinate with the Analytics Department on internal monitoring and auditing for policy compliance, discover preventive and corrective measures executed for audit findings and coordinate internal and external corrective measures to be executed.
• Work closely with other MAHP and Clinic departments for effective investigation, resolution, reporting, and remediation of compliance issues.  Prepare report for management on incidents, investigations, and all compliance issues and attend and present at Compliance Committee meetings as necessary.

Legal Guidance
• Assist Compliance, HIPAA Privacy and Security Officers in carrying out their responsibilities as necessary.


Knowledge and Skills:

Experience : Three years to five years of similar or related experience.

Education: Possess Juris Doctor (J.D.) degree from an approved law school, with admittance to at least one state bar in good standing.

Interpersonal Skills: A significant level of trust and diplomacy is required, in addition to normal courtesy and tact.  Work involves extensive personal contact with others and/or is usually of a personal or sensitive nature.  Work may involve motivating or influencing others.  Outside contacts become important and fostering sound relationships with other entities (companies and/or individuals) becomes necessary.

Other Skills: Possess relevant certification in healthcare compliance, such as or CCEP, CHC, CHC-F, or CHRC, or a Certified Fraud Examiner (CFE) certification, or successful completion of a graduate certification program in healthcare compliance.  Strong knowledge of Excel, PowerPoint, and SAP.

This listing has expired

Show housing near this job

Job Details

Req Num --
ID 654752
Location
Dubuque, IA
Positions 1
Type
Employee
Status
Full Time
Pay --
Categories
Health Care
Legal
Benefits
Health Insurance
Dental Insurance
Life Insurance
Retirement Plan
Paid Vacation
Paid Sick Leave
Paid Holidays

Preferred Candidates

Years of Experience --
Education --

accessdubuquejobs.com is a product of THMedia ©