Job Description

Job Title: Senior Administrator, Compliance
Job ID: 22689864
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Com HlthChce Compliance
Location: 600 Grant St, Pittsburgh PA 15219

Description

Purpose:
The Senior Administrator, Medicaid Compliance reports directly to the Sr. Director, Medicaid & Community HealthChoices Compliance. This position strategically works to ensure compliance with all relevant and applicable Medicaid and CHC/MLTSS laws, DHS and CMS regulations, and DHS contractual requirements and standards in a manner that continually supports the business and operational areas. Assists in the development of clear, effective and timely reports and updates for senior management and/or the Board regarding Medicaid and CHC Compliance Program effectiveness, initiatives and issues, including all relevant metrics, dashboards, and information. Works with Sr. Director and Manager to complete regular gap analyses, risk assessments, and program effectiveness assessments for the Medicaid and CHC Compliance Program.  Develops, assesses and adapts clear and effective Medicaid and CHC/MLTSS Compliance policies, procedures, training, communications and awareness materials, controls and initiatives to ensure clear and consistent understanding and practices throughout internal operations to ensure proper and timely preventive measures. Develops, assesses and adapts clear and effective remediation and corrective action initiatives, protocols and controls to ensure proper and timely compliance.
Ensures strategic and operational partnership and collaboration with the business, operational and additional compliance areas to leverage cross-departmental synergies and efficiencies. Keeps abreast of changing industry requirements and regulations, including all relevant laws, industry standards, and company practices and initiatives.  Conducts research on regulations, regulatory updates, etc. as needed. Coordinate with management in the preparation and submission of status reports to senior management and periodic updates resulting from on-site visits and/or audits.
Meet deadlines and turnaround times set by management with minimal supervision. Partner with health plan staff to ensure corrective action plans are sufficiently addressed by appropriate health plan departments.
Responsible for the accurate communication of contractual requirements and guidance throughout the health plan, as well as the internal coordination of compliance activities. Represents UPMC Insurance Services Division with all relevant regulatory agencies and entities regarding Medicaid and CHC/MLTSS Compliance reviews, investigations or requests for information. Works with Manager and other Senior Administrators to conduct annual and ongoing Medicaid and CHC/MLTSS compliance training to UPMC Insurance Services Division staff and applicable parties. Effectively lives, models, communicates and supports the values of UPMC and UPMC Health Plan. Performs in accordance with UPMC System-wide competencies and behaviors. Performs other special projects and Senior Administrator duties as assigned.


Responsibilities:
  • Responsible for oversight and preparation of audit materials, including document preparation and mock audits.
  • Assist management and health plan departments in the monitoring and oversight of third-party vendors responsible for various functions.
  • Responsible for the accurate communication of contractual requirements and guidance throughout the health plan, as well as the internal coordination of compliance activities.
  • Participate in Policy and Procedure Subcommittee meetings.
  • Manage special projects, including developing and implementing project plans.
  • Serve as a liaison to various regulators in the resolution of enrollment, payment or other regulatory issues.
  • Responsible for all managerial functions in the manager's absence.
  • Collaborate with other health plan departments to ensure regulatory filings are complete, accurate and meet required timeframes.
  • Supervise, direct and motivate Compliance Coordinators.
  • Work with management to coordinate the various elements of state regulatory filings, as needed.
  • Coordinate with management in the preparation and submission of status reports to senior management and periodic updates resulting from on-site visits and/or audits.
  • Complete special projects and assignmentsPerforms in accordance with system-wide competencies/behaviors.Performs other duties as assigned.
  • Conduct research on regulations.
  • Coordinate participation of various health plan subject matter experts in periodic committee and subcommittee meetings as well as local and/or regional conferences and workshops impacting the health plan?s ability to comply with various regulatory requirements.
  • Meet deadlines and turnaround times set by the Manager (these deadlines and turnaround times will, at times, require the employee to work until the project is completed, meaning extended daily work hours, extended work weeks, or both).
  • Partner with health plan staff in preparing accurate on-site visit reports and sending approved responses to the regulators, while working with management to ensure corrective action plans are sufficiently addressed by appropriate health plan departments.
  • Assist in the development of policies and procedures.

Qualifications

  • Bachelor's Degree required
  • Relevant graduate degree in a related field desirable, but not required.
  • 5-7 years of Health Insurance
  • Minimum of 5-7 years of demonstrated and progressively increasing experience/knowledge of healthcare regulatory compliance required
  • Excellent organizational capabilities with ability to work effectively as a team player.
  • Ability to continuously interact effectively and professionally with all levels of staff.
  • Excellent written and oral communication skills.
  • Ability to handle multiple priorities/projects in a fast-paced professional environment.
  • Demonstrated performance in meeting time-sensitive deadlines with minimal supervision.Business minded partner and collaborator who continually builds relationships, consensus and coalitions to get things done.
  • Strong emotional intelligence and self-awareness
  • Working knowledge of standard office software, including but not limited to Word, Excel, and PowerPoint.

  • Licensure, Certifications, and Clearances:

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

Salary Range: $31.82 to $54.34 / hour

Union Position: No

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