Compliance Specialist Nemt

Responsibilities:
- Act as the subject matter expert for NEMT compliance programs for state government agencies and managed care organizations, transportation provider credentialing, and insurance-related questions surrounding NEMT nationwide.

Serves as the compliance resource for day-to-day NEMT compliance related questions and processes.

Conduct various internal compliance reviews, risk assessments, gap assessments, or maturity assessments that will be used to enhance the compliance program and prepare for new and upcoming requirements.

Responsible for maintaining, implementing, and training staff on enterprise policies and procedures related to NEMT.

Performs periodic and regularly scheduled internal and sub-delegate reviews or audits to ensure company procedures are followed.

Collaborate with Finance and Claims teams to perform data monitoring, identify outliers that may indicate fraud, waste, and abuse, and perform routine compliance audits.

Collaborate with provider relations teams to conduct observations on provider performance to ensure compliance with all contractual agreements.

Coordinate and respond to health plan audits and design and implement corrective action plans.

Track and manage ongoing state and federal regulatory reporting.

Performs other related duties as assigned by management.

Requirements:
- Associate degree or equivalent preferred.

Required to have 3+ years of experience working for a Managed Care Organization, specifically with the transportation benefit, or for a transportation broker operating in multiple states.

Experience with government sponsored programs such as Medicare and Medicaid.

Proficient in Microsoft based applications.

Excellent written and oral communication skills.

Versatility, flexibility, and a willingness to work within constantly changing priorities with enthusiasm.

Acute attention to detail.

Ability to deal effectively with a variety of individuals at all organizational levels.other related duties as assigned to meet the ongoing needs of the organization.

Job Type: Full-time

Pay: $85,000.00 - $95,000.00 per year

Benefits:

• Flexible schedule
• Health insurance
• Paid time off

Schedule:

• 8 hour shift
• Monday to Friday

Work Location: Remote