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Cardinal Health OutcomesMTM Compliance Specialist in West Des Moines, Iowa

What Quality & Regulatory Audit contributes to Cardinal Health

Quality & Regulatory Audit is responsible for enforcing policies and procedures to maintain the quality of MTM claims documented in OutcomesMTM programs through clinical review of interventions documented.

Essential Functions

  • Maintain expertise in Part D MTM program reporting requirements
  • Maintain expertise in Part D MTM program CMS audit protocol requirements
  • Develop and maintain compliance program policies and procedures
  • Develop and maintain privacy program policies and procedures
  • Coordinate background checks and monthly sanction monitoring with Human Resources to determine if prospective employees, temporary employees, volunteers, board members and independent contractors are excluded or debarred from any federal healthcare or other governmental program
  • Monitor compliance curriculum training records to ensure compliance with training requirements
  • Coordinate with Quality Assurance and assisting in fraud, waste and abuse monitoring activities
  • Conduct annual compliance program self-assessments and report results to the Compliance Officer
  • Perform Medicare Part D compliance and fraud, waste and abuse risk assessments
  • Develop corrective action plans in follow-up to risk assessments, as needed
  • Perform auditing and monitoring activities of downstream and related entities
  • Coordinate across departments to develop responses to program audits
  • Monitor progress with corrective action plans, as needed
  • Continually monitor changes in the healthcare industry, the company’s business activities, applicable CMS MTM program requirements, identified weaknesses in the Program, or identified systemic patterns of noncompliance
  • Manage and maintain privacy program
  • Manage and maintain EMTM reporting
  • Other duties as assigned

Qualifications

  • Bachelors in related field, or equivalent work experience, preferred
  • 2+ years experience in related field, preferred

What is expected of you and others at this level

  • Applies working knowledge in the application of concepts, principles, and technical capabilities to perform varied tasks
  • Works on projects of moderate scope and complexity
  • Identifies possible solutions to a variety of technical problems and takes actions to resolve
  • Applies judgment within defined parameters
  • Receives general guidance may receive more detailed instruction on new projects
  • Work reviewed for sound reasoning and accuracy
  • Strong written and verbal communication skills
  • Ability to communicate across all levels of an organization, demonstrating professionalism and good judgment at all times
  • Must be able to work autonomously (with minimal direction) while also being part of an integrated team
  • Must be able to manage competing demands and multiple priorities, while maintaining a strong attention to detail
  • Technical proficiency related to PC and basic office software

Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law.

To read and review this privacy notice click here (https://www.cardinalhealth.com/content/dam/corp/email/documents/corp/cardinal-health-online-application-privacy-policy.pdf)

Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

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