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Organization TypePublic Interest
Years of Experience
Date Last Verified
ProfileAdministrator, CHC Compliance The candidate will strategically ensure compliance with all relevant and applicable Medicaid and MLTSS laws, regulations, contractual agreements, standards and requirements in a manner that continually supports the business and operational areas. Assist in the development of clear, effective and timely reports and updates for senior management and/or the Board regarding Medicaid and MLTSS Compliance Program effectiveness, initiatives and issues, including all relevant metrics, dashboards and information. Develop, assess and adapt clear and effective Medicaid and MLTSS Compliance policies, procedures, training, communications and awareness materials, campaigns, controls and initiatives to ensure clear and consistent understanding and practices throughout internal and external operations to ensure proper and timely preventive measures. Develop, assess and adapt clear and effective remediation and corrective action initiatives, protocols and controls to ensure proper and timely compliance. Develop, assess, and adapt clear and effective Medicaid and MLTSS Compliance monitoring, testing, reporting, auditing and sampling protocols, controls and channels to ensure the proper and timely detection of relevant issues. Ensure compliance with required Medicaid and MLTSS laws, regulations, contractual requirements, standards and practices for all relevant stakeholders, both internal and external to the organization. Ensure strategic and operational partnership and collaboration with the business and operational areas, as well as with sibling Governance, Risk & Compliance (GRC) teams to leverage cross-departmental synergies and efficiencies. Keep abreast of changing industry requirements and regulations, including all relevant laws, rules, contractual agreements, industry standards, company practices and initiatives. Provide clear and effective reports to the relevant business, functional and operational areas, as well as other internal/external stakeholders, regarding new or prospective Medicaid and MLTSS laws, regulations, contractual requirements, industry standards and best practices. Perform other duties as assigned. Effectively lives, models, communicates and supports the values of the Hospital’s Health Plan. Perform in accordance with Hospital System-wide competencies and behaviors. Represent Insurance Services Division in all third party- and customer-originating or facing Medicaid or MLTSS Compliance-related reviews, investigations or requests for information. Represent Insurance Services Division with all relevant regulatory agencies and entities regarding Medicaid and MLTSS Compliance reviews, investigations or requests for information. Work with Sr. Director to complete regular gap analyses, risk assessments and program effectiveness assessments for Medicaid and MLTSS Compliance Programs. Work with Sr. Director to conduct annual and ongoing Medicaid and MLTSS Compliance training to Insurance Services Division staff and applicable parties. Bachelor’s degree required. Relevant graduate degree (e.g. Juris Doctor or Masters degree in a related field) preferred. 5+ years of Medicaid and/or LTSS legal and/or compliance experience required, preferably on the insurance (payer) side required. Prior in-house legal or compliance experience strongly preferred. Pennsylvania-specific Medicaid and/or LTSS experience preferred. Successful experience in designing and building highly effective relevant compliance programs from scratch and/or significantly enhancing such programs strongly preferred. Strong: subject matter expertise and knowledge of all relevant Medicaid and LTSS laws, regulations, contractual requirements, industry standards and best practices; acumen and understanding of healthcare, health insurance and managed health care industries and organizations required. Excellent oral, listening and written communication skills required.
Job ID: 590773