Job Details

Director Of Contracting And Compliance

Company name

Center for Elders' Independence.

Organization Type

Public Interest

Job Type

Non-practicing Attorney

Date Last Verified

Jun 18, 2020

Valid Through

Oct 01, 2020

Posted on

May 29, 2020

Years of Experience

Min 5 yrs required

Location

Oakland, CA, United States

Employment Type

Full-time

Industry

Legal
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Director of Contacting and Compliance
Duties: Serve as lead to the Contracts and Compliance Departments. This overlap in management responsibilities is appropriate at CEI as these two functions require a broad knowledge and oversight of internal and external provider compliance and program development. Works closely cross functionally to maximize operational and financial efficiency and to ensure CEI compliance with state and federal regulations. Report directly to the CEO and CFO. Collaborate with the Leadership Team to Develop specific objectives to support the overall strategic network and vendor relationship objectives. Negotiate and execute third party contracts, including medical/healthcare sourcing. Tracking and maintaining of contracts, and ensuring timely execution of quality deliverables, including oversight of collaborative partners in the community (SNFs, RCFEs) regulatory reporting, execution and reporting of correction action plans related to audits. Develop, manage, and sustain external provider network and relationship; ensure appropriate reimbursement and resolution of claim payment issues. Oversee documents through the contracting process, including review of documents. Oversight of contract systems as the business owner and documentation, including contract terminations, modifications, extensions, amendments, and renewals. Monitor and maintain compliance with regulatory agencies and established company procedures. Oversee clinical provider credentialing and re-credentialing in conjunction with Human Resources. Establish and maintain strong business relationships with hospital, physician, pharmacy, or ancillary providers, and ensuring the network composition includes an appropriate distribution of provider specialties. Develop the provider network yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management, and produces an affordable and predictable product for customers and business partners. Evaluate and ensure negotiated contracts are in compliance with company contract templates, reimbursement structure standards, and other key process controls. Develop subject matter expertise with electronic contract management system. Anticipate customer needs and proactively develop solutions. Manage contracting staff. Develop, initiate, maintain, and revise policies and procedures for the general operation of the Compliance Program and its related activities to prevent illegal, unethical, or improper conduct. Manage day-to-day operations of the Program. Review and analyze regulations and regulatory changes based on an intimate knowledge of CEI and the PACE model to maintain continuing currency and relevance in providing guidance to management and employees. Collaborate with other departments to direct compliance issues to appropriate existing channels for investigation and resolution. Coordinates implementation of strategies and programs necessary for governmental approval of CEI’s services and offerings. Respond to alleged violations of rules, regulations, policies, procedures, and Standards of Conduct by evaluating or recommending the initiation of investigative procedures. Develop and oversee a system for uniform handling of such violations. Contributes toward developing and modifying policies and procedures to conform to legal requirements. In coordination with CEI Leadership, act as an independent review and evaluation body to ensure that compliance issues/concerns within the organization are being appropriately evaluated, investigated and resolved. Organize routine compliance meetings with department managers and leadership. In coordination with CEI Leadership, ensure proper reporting of violations or potential violations to duly authorized enforcement agencies as appropriate and/or required. Work with the Human Resources Department and others as appropriate to develop an effective compliance training program, including appropriate introductory training for new employees as well as ongoing training for all employees and managers. Monitor the performance of the Compliance Program and relate activities on a continuing basis to the Board of Directors and leadership, taking appropriate steps to improve its effectiveness. Management of Compliance Analysts/Specialists in the administration of the Compliance Program. In addition to the Duties and Responsibilities outlined above, this position is expected Perform other duties as assigned in a positive and helpful manner.

Qualification and Experience

Qualifications: BA/BS Required, Masters degree in health or business-related field, i.e. MHA, MPH, MBA, etc. or JD Degree preferred. 5+ years of experience in health care network management-related role handing complex network providers with accountability for business results. Payer experience highly desirable. 5+ years of experience in healthcare compliance and familiarity with operational, financial, quality assurance, and human regulation procedures and regulations. Experience in contributing to the development of product pricing and utilizing financial modeling in making rate decisions. Understanding of market-related issues, contract development, negotiation, third party contracting. Expert level of knowledge of Medicare/MediCal reimbursement methodologies and regulations. Knowledge of contracting, legal and the healthcare industry. Knowledge of regulatory agency requirements, State and Federal law. Collaborative and works effectively as a team member with strong interpersonal skills. Self starter with strong attention to detail and organization skills. Ability to perform under tight deadlines and thrive in a fast-paced environment. Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information. Excellent leadership, strategy, management, and organizational skills. Ability to perform under tight deadlines and thrive in a fast-paced environment.

Company info

Hiring Coordinator
Center for Elders' Independence.
510 17th Street
Oakland, CA 94612

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