Job Description

Job Title: Administrator, Third Party Compliance
Job ID: 778282
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Compliance & Risk Ops
Location: 600 Grant St, Pittsburgh PA 15219

Description

Purpose:
The Administrator, Third-Party Compliance Oversight reports to the Sr. Director, Risk Management & Compliance Operations. This position monitors and evaluates the performance of delegated third-parties according to CMS, federal, and state requirements in a manner that continually supports the business and operational areas.

This is a new compliance program that we are standing up, it is a great opportunity for someone to learn all LOBs. The other compliance areas within our department are dedicated to specific LOBs but this role would gain exposure to all of them. The purpose of the new team is to build a program to mitigate our risk with third-parties and to monitor and audit them to ensure that they are in compliance with all applicable requirements.

Responsibilities:
  • Assists in the development of clear, effective and timely reports and updates for senior management and/or the Board regarding Third-party Oversight Compliance Program effectiveness, initiatives and issues, including all relevant metrics, dashboards and information.
  • Coordinates and performs on-going monitoring of third-party activities to ensure compliance.
  • Develops and maintains oversight document evidence related to compliance oversight in preparation for state, federal and regulatory audits. Monitors and audits delegated third-parties to ensure compliance with state and federal requirements. Executes compliance monitoring plans to monitor delegated third-parties to meet regulatory oversight and compliance requirements.
  • Develops/maintains reporting and metrics for delegated third-party activities. Ensures timely receipt of accurate and complete reporting for all regulatory and contractually required reports for delegated third-parties.
  • Manages and monitors third-parties against CMS, contractual, federal, and state requirements.
  • Monitors external and internal reports to ensure compliance with regulatory requirements. Develops, assesses and adapts clear and effective remediation and corrective action initiatives, protocols and controls to ensure proper and timely compliance. Keeps abreast of changing industry requirements and regulations, including all relevant laws, rules, contractual agreements, industry standards, company practices and initiatives.
  • Oversees the process for completing Third-Party Pre-Qualification/Delegation Assessments. Distributes and oversees the process for Third-Party Annual Attestations. Conducts risk assessments for each third-party.
  • Provides clear and effective reports to the relevant business, functional and operational areas, as well as other internal/external stakeholders, regarding new laws, regulations, contractual requirements, industry standards and best practices. Ensures strategic and operational partnership and collaboration with the business and operational areas, as well as with GRC teams to leverage cross-departmental synergies and efficiencies.
  • Works closely with the Governance, Risk & Compliance (GRC) teams (CHIP, Exchange, Medicare, Medicaid, Community Health Choices, CCBH, Commercial) for dissemination of new or revised requirements applicable to the delegated third-party.

Qualifications

  • Bachelors degree required. 
  • Minimum of Four to Five (4-5) years of delegation oversight, vendor management, healthcare government programs, and/or compliance experience required, preferably on the insurance (payer) side. 
  • Strong subject matter expertise and knowledge of all relevant laws, regulations, contractual requirements, industry standards and best practices required. 
  • Strong acumen and understanding of healthcare, health insurance and managed health care industries and organizations required. 
  • Excellent oral, listening and written communication skills. 
  •  Strong project management skills and experience required. 
  • Must have strong analytical and organizational skills as well as problem-solving capabilities to ensure that business plans and strategies do not subject the organization to legal, regulatory or contractual violations and/or undue risk or exposure.  
  • Strong partnership, relationship- consensus and coalition-building skills required. 
  •  Strong emotional intelligence and self-awareness required. 
  •  Strong strategic, business, operational and leadership mindset and skills required.  
  • Highly consultative and partnership-oriented in approach. 
  • Ability to interact with all levels of leadership, influence change, adoption of third-party compliance oversight concepts, and lead cross-functional initiatives. Strong and reliable judgment and discretion required.  
  • Strong ability to independently and self-sufficiently identify, navigate and successfully resolve various issues.  
  • Strong ethical compass and integrity capital required.

Licensure, Certifications, and Clearances:
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $29.22 to $49.32 / hour

Union Position: No

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