Vendor Compliance Specialist
Job Ref: 56740
Department: OFFICE CORPORATE COMPLIANCE
Location: 160 Water St. #3, New York, NY
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $70,000.00
Salary Range: $70,000.00 - $80,000.00
MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
Reporting to the Director of Corporate Compliance and Privacy, the Vendor Compliance Specialist is the designated resource for MetroPlus’ Vendor Compliance Program. Working with the Plan’s Subject Matter Experts (SMEs), this individual will assist the Director in providing oversight of MetroPlus’ First Tier, Downstream and Related Entities
(FDRs) and other vendors that perform administrative and health care service functions on behalf of the Plan to ensure compliance with all contractual and regulatory obligations. This individual is also responsible for identifying and tracking potential operational risks posed by a vendor’s activity.
- Assists in the performance of risk assessments for each delegated entity, and ensures reporting, monitoring, and audits capture the review of the risks identified.
- Participates in strategic planning of delegation activities, as well as initiative to improve quality and service provided by Vendors. May lead work teams, work groups and committee discussions to address specific delegation standards requiring focused attention.
- Identifies deficiencies and proposes solutions to support the implementation of updated or new regulatory standards, as well as lead and ensure full compliance with requirements.
- Evaluates vendor compliance with organizational delegation requirements; conducts ongoing monitoring, data/documentation collection and reporting to ensure continued adherence to organizational requirements; monitors delegate/vendor documentation for compliance with applicable standards and regulatory compliance.
- Issues and monitors Corrective Action Plans (CAPs) to delegated vendors and work with subject matter experts and contract managers to ensure completion in timely manner.
- Prepares materials for the Vendor Delegation Oversight Subcommittee (VDOS), which serves as a forumto report and monitor performance of all delegated entities. Report findings and outcomes from the VDOS to governing committees and Executive Leadership.
- Participates in annual and ongoing audits of delegated entities. Audits include a review of related policies and procedures, review of downstream oversight, and compliance with regulatory and plan requirements.
- Responsible for the issuance of final audit report, along with any corrective action plans needed.
- Establishes a process to review and evaluate the Vendor Compliance Program annually.
- Bachelor's Degree in a health-related field, Master’s Degree preferred.
- Three (3) or more years of profession experience in health plan compliance and/or oversight programs.
- Knowledge of managed care regulations and health insurance laws, especially in relation to vendor
- Experience working with regulatory agencies such as the CMS and state regulators.
- Experience organizing, coordinating, and participating in FDR monitoring and auditing.
Licensure and/or Certification Required
- CHC preferred
- Integrity and Trust
- Customer Focus
- Understanding of and demonstrated experience with process improvement and program/project
- In depth knowledge of health care policy environments or policy related roles with demonstrated
- knowledge of leading and supporting cross-departmental employee stakeholders.
- Demonstrated knowledge of managing and building relationships with stakeholders, including senior
- management, with strong influencing and negotiation skills.
- Excellent written and oral communication skills, with ability to convey complex information in an
- accessible way as well as prepare and give presentations to diverse audiences.
- Demonstrated ability to manage multiple projects, including managing departmental workload in line with
- the organizational strategy, successfully managing working groups, and proven project management
- Excellent interpersonal skills with a high level of diplomacy and political awareness, and ability to work
- effectively as a member of the senior management team.
- Sound working knowledge of Windows-based software packages, including Word, Excel, PowerPoint,
- SharePoint, and Visio as well as online/Internet-based research tools.
- The ability to comprehend and interpret regulatory, legislative, and contractual mandates.
- Experience with managed care, Medicare and federal and/or state regulations and quality improvement.
- High-level of skill in leading interdepartmental and cross-functional strategy development; experience
- managing professional staff on multiple projects to ensure corporate deadlines and objectives are met.
- Simultaneously manage multiple projects.
- The utmost integrity in the discreet and confidential handling of confidential materials is necessary.
- Creative problem-solving abilities.