- Provide implementation oversight by ensuring regulatory requirements have been effectively implemented by the internal and external business areas, including but not limited to:
- Synthesize regulatory guidance into Compliance activities.
- Track related due dates, updates and maintains Compliance Department trackers.
- Escalate items at risk for noncompliance.
- Ensure business area has implemented regulatory requirements by collecting documentation that demonstrate that the process, operations, trainings, policies, job aides have been updated, as applicable for a compliant close out.
- Conduct compliance reviews of operational policies and procedures to ensure adherence to regulatory and contractual obligations.
- Ensure proper investigation of all Medicare regulatory compliance related issues.
- Supports Compliance leadership in:
- External audits or regulatory requests as needed.
- Assisting in the development of the annual risk assessment and implementation of the annual work plan ensuring the gathering and provision of Medicare regulatory compliance related information.
- The regular development and review of Regulatory Compliance policies and procedures for the general operation of the Plan's compliance program and its' related activities for the Medicare line of business.
- Implementation of Compliance Work Plan activities.
- Contributes quality and timely data for the materials prepared for both the Internal Compliance Committee Meetings and Audit and Compliance Subcommittee of the Board of Directors.
- Other duties as requested
- Bachelor's degree required.
- 4 years of managed care experience required, preferably in regulatory affairs/compliance.
- Experience with implementation of HPMS Memos, CMS Final Rules and Medicare Managed Manuals.
- Experience with operational implementation of Part C & D requirements and understanding operational workflows and processes.
- Experience in driving corrective action plans (CAPs) and compliance issue resolutions.
- CHC, CCEP Preferred
- Strong knowledge and experience with managed care, Medicare regulations/requirements, operational process improvement and compliance oversight.
- Ability to work independently and effectively.
- High-level of skill in leading interdepartmental and cross-functional strategy development; experience managing professional staff on multiple projects to ensure corporate deadlines and objectives are met. Simultaneously manage multiple projects
- Excellent oral, written, and presentation skills, as well as conceptual and analytic skills are necessary to review and articulate corporate objectives and Federal regulations across all relevant audiences.
- The utmost integrity in the discreet and confidential handling of confidential materials is necessary
-
Compliance Specialist
2 weeks ago
ADAPT Community Network New York, United States**Why Join ADAPT?** · It's more than a job; it's a calling. It's where passion meets purpose. ADAPT Community Network, formerly United Cerebral Palsy (UCP) of NYC provides a multitude of services to people with developmental disabilities. At ADAPT, we are 3,000 strong, and it tak ...
-
Compliance Specialist
2 weeks ago
New York City Housing Development Corporation (HDC) New York, United States· **Position Summary**: · The Compliance Specialist reports to the Assistant Vice President of Compliance and is responsible for monitoring and evaluating compliance within HDC's Low Income Housing Tax Credit (LIHTC), Tax Exempt Bond (TEB), and Taxable Bond (TB) properties. · ** ...
-
Compliance Specialist
2 days ago
Sun River Health Manhattan, United StatesSun River Health provides the highest quality of comprehensive primary, preventative and behavioral health services to all who seek it, regardless of insurance status and ability to pay, especially for the underserved and vulnerable. Sun River Health is a Federally Qualified, Non ...
-
Compliance Specialist
1 day ago
MMC Corporate New York, United StatesMercer, a place where extraordinary individuals can do their best work and lead their best lives We believe in camaraderie and collaboration, no matter what your role, level, experience or background. · **Compliance Specialist** · **What can you expect?** · - The team at Mercer w ...
-
Medicare Compliance Specialist
1 week ago
MetroPlusHealth New York, United States**Empower. Unite. Care.**: · **MetroPlusHealth** is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud ...
-
Contract and Compliance Specialist
2 weeks ago
Upwardly Global New York, United States**Title: Contract and Compliance Specialist** · **Department: Finance** · **Reports to: Director of Budget and Grants Compliance** · **Location: New York, San Francisco, Chicago or DC** · **FLSA Status: Exempt** · **About the Organization** · Over the years, Upwardly Global has s ...
-
HR Compliance Specialist
3 weeks ago
The College Board New York, United StatesHR Compliance Specialist (temp) · - College Board - Global Strategy & Talent- work location · - is regularly commutable for you. · Type: This is a temp position expected to last 3-6 months from the start date · - Anticipated Start date: May 7 · - About the Team · - The Talent tea ...
-
Compliance and Audit Specialist
1 week ago
DocGo New York, United StatesTITLE: COMPLIANCE & AUDIT SPECIALIST · - SALARY: $72,500-$82,000 · - LOCATION: DocGo HQ, 35 W 35th St. New York, NY 10001 · - EMPLOYMENT TYPE: Full Time, On-Site · - BENEFITS: Medical, Dental, and Vision (with company contribution), Paid Time Off, 401k · ABOUT DOCGO: · - DocGo is ...
-
Environmental Compliance Specialist
3 weeks ago
FMC Corporation Newark, United StatesFMC Corporation is a global agricultural sciences company dedicated to helping growers produce food, feed, fiber and fuel for an expanding world population while adapting to a changing environment. FMC's innovative crop protection solutions - including biologicals, crop nutrition ...
-
Lead HR Compliance Specialist
3 weeks ago
Starbucks New York, United States**Now Brewing - Lead HR Compliance Specialist -#tobeapartner** · **From the beginning, Starbucks set out to be a different kind of company**. One that not only celebrated coffee and its rich tradition but also brought a feeling of connection. We are known for developing and suppo ...
-
Wealth Management Compliance Specialist
3 weeks ago
EF Hutton New York, United States**The Company** · EF Hutton is a fast-paced, high-growth, global investment bank founded by experienced investment professionals that have collectively financed over $250 billion for public and private companies alike. EF Hutton offers strategic advice and financing solutions to ...
-
Academic and Compliance Specialist
3 weeks ago
Eastern International College Jersey City, United StatesThe Academic and Compliance Specialist (ACS) leads and coordinates the development of new academic programs and ensures regulatory compliance with State and accreditation standards and procedures. The ACS also coordinates, formulates, and conducts faculty professional development ...
-
Compliance Specialist
3 days ago
Center for Justice Innovation Brooklyn, United StatesTHE ORGANIZATION · The Center for Justice Innovation (formerly the Center for Court Innovation) is a non-profit organization that works with communities and justice systems to advance equity, increase safety, and help individuals and communities thrive. The Center's goal is to i ...
-
Environment of Care Compliance Specialist
1 week ago
NewYork-Presbyterian Hospital Manhattan, United States**Environment of Care Compliance Specialist - Facilities** · This position is responsible for monitoring and tracking the organization's compliance with, and also providing regulatory expertise and guidance as it relates to The Joint Commission's Environment of Care (EOC), Life S ...
-
Bob- Environmental Compliance Specialist
1 week ago
NYC Careers New York, United States**BOB- Environmental Compliance Specialist**: · - Apply**BOB- Environmental Compliance Specialist**: · - Agency: DEPARTMENT OF TRANSPORTATION · - Posted on: 05/24/2024- Job type: Full-time · Location · NYC-ALL BOROS · - Title Classification: No exam required · Department · Qualit ...
-
Compliance Specialist
5 days ago
Center for Justice Innovation Brooklyn, United StatesTHE ORGANIZATION · The Center for Justice Innovation (formerly the Center for Court Innovation) is a non-profit organization that works with communities and justice systems to advance equity, increase safety, and help individuals and communities thrive. The Center's goal is to i ...
-
Compliance Specialist
1 week ago
Center for Justice Innovation New York, United StatesJob Description · Job DescriptionTHE ORGANIZATION · The Center for Justice Innovation (formerly the Center for Court Innovation) is a non-profit organization that works with communities and justice systems to advance equity, increase safety, and help individuals and communities t ...
-
Compliance Specialist
3 weeks ago
Cresilon Inc Brooklyn, United StatesThe Compliance Specialist provides guidance and ensures compliance with ISO13485 & 21 CFR Part 820 and applicable good manufacturing practice regulations within the company. Also provides support to delivery, drive and maintain effective Product Quality Surveillance. · Responsib ...
-
Compliance Specialist
1 week ago
Cresilon, Inc. New York, United StatesJob Description · Job DescriptionThe Compliance Specialist provides guidance and ensures compliance with ISO13485 & 21 CFR Part 820 and applicable good manufacturing practice regulations within the company. Also provides support to delivery, drive and maintain effective Product Q ...
-
Specialist in Compliance
3 weeks ago
NebulaWorks Clifton, United StatesA publicly listed German reinsurance company specializing in various areas of property and casualty and life reinsurance is seeking a Compliance Management System Specialist (m/f/d). You will benefit from a pleasant working environment and numerous development opportunities. · Yo ...
Medicare Regulatory Compliance Specialist - Brooklyn, United States - MetroPlus Health Plan
Description
Medicare Regulatory Compliance Specialist
Job Ref: 106703
Category: Professional
Department: OFFICE CORPORATE COMPLIANCE
Location: 50 Water Street, 7th Floor,
New York,
NY 10004
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $75,000.00
Salary Range: $75, $88,000.00
Empower. Unite. Care.
MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.
About NYC Health + Hospitals
MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
Position Overview
Reporting to the Senior Manager of Medicare Regulatory Compliance, the Medicare Regulatory Compliance Specialist will support the oversight and management of the Medicare Compliance Program. The Specialist will support Medicare regulatory implementations and the correction and remediation of compliance issues. The Medicare Regulatory Compliance Specialist will assist in driving overall compliance with Medicare requirements.
Job Description
Minimum Qualifications
Professional Competencies
#LI-HYBRID
