Director Of Compliance Operations

MetroPlusHealth 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, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

Reporting to the Vice President of Compliance, the Director of Compliance Operations is an essential part of the overall Compliance Program and is responsible for ongoing reporting and infrastructure needs of the department

• Continually assess the effectiveness of departmental functioning, including the people, processes and technologies needed to achieve departmental and corporate goals and objectives.
• Identify problems and opportunities for improvement and generate creative solutions that improve qualitative and quantitative performance.
• Support the annual plan risk assessment and collaborating with the Compliance teams, to assist in identifying areas with potential compliance issues and develop work plan activities.
• Develops and manages reporting dashboards for the Compliance Department. Works with departments within Compliance to understand processes and reporting needs.
• Sources data required for Compliance auditing and monitoring activities.
• Build and maintain tools and applications in the Compliance GRC system for the general use of the Division.
• Support external auditing activity by producing requested information/documentation from internal systems.
• Collaborates with Compliance areas to compile regulatory response.
• Keep up to date on the latest developments, federal and state laws, and regulations.
• Other activities as assigned by the Vice President of Compliance or Chief Compliance and Regulatory Officer.
  

• Bachelor’s degree from an accredited institution
• 7-10 years of experience in managed care organization compliance/auditing or healthcare compliance (experience with billing, claims process, Medicaid, Medicare, ACA, medical record review, investigation of problematic issues).

Licensure and/or Certification

• Healthcare Compliance or Internal Audit Certification (preferred)

Professional Competencies

• Technical knowledge of applicable standards and regulatory requirements.
• Knowledge and ability to develop applications/modules in low-code platforms.
• Ability to function independently with limited direction.
• 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 English, with proven ability to research and edit accessible, clear policy and procedure documents as well as reports for diverse audiences.
• Excellent 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 skills.
• 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.

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