Manager of Contracts & ComplianceMedical Associates, Dubuque, IA
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Our mission is to provide superior healthcare and an excellent patient experience.
Medical Associates Clinic is a well-established multispecialty group practice with over 170 providers and a staff of over 1,000 health care professionals and support personnel. The group was founded in 1924 and is Iowa’s oldest multispecialty group practice. Today, Medical Associates Clinic is the area’s leading health care provider and only multispecialty group practice. Medical Associates Clinic has been recognized since 1998 as a “better performing practice” by the Medical Group Management Association.
In 1982, Medical Associates developed the Tri-State’s first health maintenance organization, Medical Associates Health Plans, which offers comprehensive health benefits to over 400 employers and 45,000 members. Medical Associates Health Plans has maintained an “Excellent” rating, the highest level of accreditation possible by the National Committee for Quality Assurance, for 13 consecutive years.
Medical Associates Clinic offers several locations from which to seek medical care, including facilities at 1500 Associates Drive, 1000 Langworthy, and 1940 Elm Street in Dubuque, Iowa; as well as facilities in Bellevue, Cascade, Dyersville, Elkader, and Monona, Iowa; Cuba City, and Platteville, Wisconsin; and Elizabeth and Galena, Illinois.
Medical Associates Clinic & Health Plans as an exceptional opportunity for you to join our growing team as a Manager of Contracts & Compliance.
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.
• 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.
• 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.
• 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.
• 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.
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Paid Sick Leave
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