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   Current UPMC employees must apply in HR Direct

Administrator, Third Party Compliance

Description

Shape the world of health care by joining UPMC! As a leader in the industry, we are committed to enhancing the lives of all who are a part of our community. Without our employees, we would not be able to innovate health care for our patients and health plan members. From hospitals to our corporate office, all UPMC employees impact our mission of creating life changing medicine. To continue our tradition of excellence, we are in search for an  Administrator, Third Party Compliance to join this community as well.


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.

Someone with delegated third-party (vendor) oversight such as Medicare FDRs (First Tier/Downstream related entities) would be preferred. Health Compliance or delegation experience with vendors in insurance or other industry is also a strong preference. 

This department offers flexible, hybrid, work arrangements based upon business needs and performance. 

Responsibilities:

  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • Manages and monitors third-parties against CMS, contractual, federal, and state requirements.

 

Qualifications

  • Bachelor's 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/Disability/Veteran

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   Current UPMC employees must apply in HR Direct