Medical Associates Manager of Contracts & Compliance in Dubuque, Iowa
Posting Close Date
Manager of Contracts & Compliance
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.
Reaching - Extending hand(s) and arm(s) in any direction.
Lifting - Raising objects from a lower to a higher position or moving objects horizontally from position-to-position. This factor is important if it occurs to a considerable degree and requires the substantial use of the upper extremities and back muscles.
Fingering - Picking, pinching, typing or otherwise working, primarily with fingers rather than with the whole hand or arm as in handling.
Grasping - Applying pressure to an object with the fingers and palm.
Talking - Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly or quickly.
Hearing - Perceiving the nature of sound with or without correction. Ability to receive detailed information through oral communication and to make fine discriminations in sound, such as when making fine adjustments on machined parts.
Vision - 20 / 40 or better in the best eye with or without correction.
Repetitive Motions - Substantial movements (motions) of the wrists, hands and/or fingers.
Sedentary Work - Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs
are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
Environmental Conditions: None - The worker is not substantially exposed to adverse environmental conditions (such as in typical office or administrative work).
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.
Please view Equal Employment Opportunity Posters provided by OFCCP
- The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access
to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure
is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41