- Required Work Experience
- 1 year of managed care compliance experience
- 3 years of experience in public sector service delivery, program development, management, and administration
- Required Education
- Bachelor's Degree in Business Administration in Public Health or a related field
- Required Licenses
- N/A
- Required Certifications
- N/A
- Preferred Work Experience
- N/A
- Preferred Education
- Master's in Business Administration in Public Health or a related field
- Preferred Licenses
- N/A
- Preferred Certifications
- N/A
- Tracks and monitors progress of all recurring contract deliverables ensuring coordination and timely submission and resubmissions.
- Tracks and monitors progress of all regulatory ad hoc inquiries and deliverables ensuring coordination and timely submission.
- Facilitate AHCCCS operational reviews or other regulatory audits.
- Document management including uploading and downloading of data between Medicaid Segment and regulatory agency.
- Disseminate AHCCCS ACOM/AMPM Policy changes to stakeholders and facilitate appropriate internal policy updates.
- Coordinates with key stakeholders review and timely public comment submissions for AHCCCS policy updates as they go up for public comment.
- Data analysis, management and reporting on a recurring and ad-hoc basis.
- Database management and development for deliverables application, compliance application and OGA database.
- Contributes to executive and quality improvement processes and participates with senior staff, management, and work teams to accomplish projects, goals and standards.
- Models and promotes the core values of Medicaid Segment Arizona for which they are responsible.
- This position requires the employee to reside in Arizona within the assigned Geographical Service Area in Greater Arizona.
- Perform all other duties as assigned
- The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements
- Required Job Skills
- General knowledge of Medicaid Segment and Medicare
- General knowledge of healthcare operations
- Knowledge of laws, rules, regulations, policies, and legal practices related to health and behavioral health, managed care, professional practice, nonprofit corporations, employment, contracts, and civil practice.
- Demonstrated experience and expertise with successful contract management and compliance oversight.
- Knowledge of and demonstrated ability related to contract compliance regulations associated with behavioral health care administration and managed care organizations.
- Knowledgeable of and maintaining compliance with contract requirements related to the job responsibilities outlined in the job description.
- Required Professional Competencies
- N/A
- Required Leadership Experience and Competencies
- N/A
- Preferred Job Skills
- Knowledge of HIPAA privacy regulations and rules is helpful
- Preferred Professional Competencies
- N/A
- Preferred Leadership Experience and Competencies
- N/A
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Compliance Administrator - Phoenix, United States - Blue Cross Blue Shield of Arizona
Description
Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.
AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
PURPOSE OF THE JOB
The Compliance Administrator is responsible for tracking Medicaid Segment Arizona's overall compliance related to Medicaid Segment, DSNP and NCQA contract provisions and the submission of all contract deliverables to Regulators.
This position will be responsible for coordinating with the P&P coordinator to ensure all relevant policies have been updated prior to the policy effective date as required by the Medicaid Segment and Medicare contracts.
This position will be responsible for producing data reports on a recurring or ad hoc basis.QUALIFICATIONS
REQUIRED QUALIFICATIONS
REQUIRED COMPETENCIES
AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
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