Medicaid Program Integrity Jobs in Kentucky (NOW HIRING)

• Location 2186 Water Street,Port Huron, MI, 48060,United States
• Base Pay $61,200.00 / Year
• Employee Type Full Time

Contact information

• Name HR
• Phone 810-966-3399

Description

Essential Functions

The Manager of the Corporate Compliance Department is an administrative position with responsibility in providing direction for corporate compliance activities for Region 10.

• Serve as Corporate Compliance Officer
• Develop and Implement the PIHP Annual Compliance Plan
• Manage the Region 10 PIHP Compliance Program
• Supervise Compliance Department
• Serve as Chair of the PIHP Regulatory Compliance Committee Meetings
• Participate on Statewide Compliance Officers Workgroup
• Attend MDHHS / OIG Meetings
• Oversee MDHHS-OIG Program Integrity Reporting including:
  • Ensure quarterly submissions are timely
  • Ongoing communication to staff and Network regarding updates (as needed)
  • Education to staff and Network regarding updates (as needed)
• Provide oversight for Corporate Compliant Complaint Review and Investigation:
  • Including OIG Referrals, provider fraud referrals, claims verification, site visits and complaint reporting
• Chair PIHP Corporate Compliance Committee
• Oversight all compliance investigation:
  • Develop data analytic strategies for detecting fraud and abuse
  • Tract data
• Provide Oversight:
  • Primary Source Verification
  • Business Associate Agreements
  • Policy development and reviews
  • Conflict of Interest
• Oversee external quality reviews in the area of Compliance
• Meet with regional Corporate Compliance Officers

Minimum Qualifications (An employee must have the following credentials, training, and experience)

• Master’s Degree in behavioral health or related field
• Experience in the area of Corporate Compliance
• Two years of experience supervising staff
• Experience working at Pre-Paid Inpatient Health Plan (PIHP), Community Mental Health (CMH) or SUD provider agency
• Experience with privileging and credentialing
• Knowledge of the Michigan Medicaid Provider Manual
• Experience in writing reports, analyzing data and administrative projects
• Ability to be a “work leader” (of a person or function), or advise others
• Experience in managing projects and teams
• Excellent organizational and writing skills
• Demonstrated knowledge of Microsoft Word and Excel
• Ability to exercise some flexibility in problem solving, when expected results are clear and generally set by others, provided certain outcomes are avoided
• Ingenuity is required to adapt, alter, or improvise alternatives when unexpected situations occur
• Ability to exercise discretion and some flexibility in selecting an optimal solution from established alternatives to obtain the desired outcome
• Ability to use or exert influence in a work process
• Ability to provide, exchange or explain information which conveys an opinion or evaluation of the facts or analyses
• Ability to develop and/or maintain effective work relationships with new, established, or non-receptive individuals/organizations through tact, diplomacy, and persuasion
• Basic knowledge of MDHHS reporting
• Basic knowledge of State of Michigan Medicaid Provider Manual
• Valid State of Michigan Driver’s License
• Must have access to transportation

Preferred Qualifications

• Five years of experience supervising staff
• Five years of experience working in Corporate Compliance
• Experience with Microsoft PowerPoint
• Advanced knowledge of MDHHS PIHP/CMH reporting
• Advanced knowledge of State of Michigan Medicaid Provider Manual

Summary

Overview: Region 10 is committed to being a premier employer by enhancing the lives of our team and supporting their growth as people and professionals. $1500 sign-on bonus available. We provide competitive wage scales that reward experience and performance, ongoing career development and training opportunities, excellent health coverage, generous paid time off with additional performance-based incentives, 13 paid holidays, flexible scheduling, and a comprehensive benefit program.

NOTICE TO APPLICANTS

• This position will be hired as employment-at-will.
• Any offer of employment is contingent upon a Criminal Background Check, as well as a 5 Panel Drug Screen.
• Region 10 PIHP embraces an employment environment that promotes recovery and discovery, a person-centered approach to treatment/services, and cultural competence. An employee in this or any position is expected to support the employment environment.
• Region 10 PIHP provides equal employment opportunities (EEO) to applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Region 10 PIHP complies with applicable state and local laws governing nondiscrimination in employment.