As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the
resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
The Compliance Manager is responsible for the oversight and enforcement of compliance requirements of managed care operations throughout CMS.
Job Duties and Essential Functions:
Manages the preparation, submission and maintenance of monthly reports to outside regulators timely and document submission of such.
Prepares routine internal reports of compliance monitoring and performance for review by middle and upper management.
Develops and fosters professional relationships with health plan contacts.
Develops and implements effective external and internal corrective action plans in coordination with the relevant department heads as needed.
Maintain active rapport with department heads and assist them in adhering to their contractual obligation to submit routine reports to outside regulators timely.Accomplished by keeping Access database of reports up-to-date and supplying reminder and status reports at the beginning and conclusion of each month, respectively.
Keep abreast of regulations impacting managed care operations departments.Prepare summary of regulatory and legislation changes at least annually.
Manage performance of subordinates to achieve operational and financial objectives of department.Review work performance and recommend merit increases, promotions and discharge actions.Liaise with Human Resources in employee relation issues.
Lead the Corrective Action Plan and Regulatory Action Plan Committee for CMS.Develop and maintain oversight tools to ensure monitoring company compliance issues to completion.
Coordinate and conduct internal audits in preparation for payor and regulatory audits including claims and utilization management.
Develop tools to improve the efficiency and preparedness of departments for regulatory and payor audits.
Perform other professional quality work as directed by the compliance manager.
May require sitting for long periods of time; also stooping, bending and stretching for materials and supplies; lifting supplies and cases of paper; manual dexterity sufficient to operate a keyboard, typewriter, calculator, telephone, copier and other equipment as necessary.Vision must be correctable to 20/20 and hearing must be in the normal range for telephone use. Must possess stamina for extended work hours.Ability to drive throughout the area.
Bachelor degree in Business Administration required
At least 3 years experience in compliance with a healthplan or MSO
Excellent written and oral communication skills.
Highly developed analytical skills.
Able to work effectively with limited supervision and with all levels of the organization.
Expert or highly proficient user of Microsoft Word, Excel, and Access.
EZCap or other closely related system.
At least 5 years of managed healthcare experience preferred.
Excellent leadership skills.
KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Ability to work independently with little supervision and seek guidance as needed to clarify assignments or request for information.
Excellent communication, customer service and time-management skills
Possess basic business skills, an understanding of general compliance operations and department goals in the healthcare environment.
Proficient with various desktop applications such as Microsoft Excel, Word, PowerPoint and/or Access.
Intermediate knowledge of relational database management systems
Must be a team player - Always willing to help in whatever way possible and go the extra mile to get the job done.
Intuitive and skilled at problem solving in anticipation of customer request
Have the ability to make logical correlations between data points to determine if analysis is accurate
Detail oriented, meticulous and accurate in completing tasks on time.
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
Bachelors Degree in Business, Information Systems, Health Care Administration or related field or equivalent years of related Analyst experience required.
Include minimum certification required to perform the job.
Project Management Professional (PMP) is preferred
Certified Healthcare Compliance (CHC) is preferred
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Must be able to work in sitting position, use computer and answer telephone
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Office Work Environment
Job: Managers and Directors
Primary Location: Encino, California
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Internal Number: 1905034313
About Conifer Health Solutions
“Tenet Healthcare Corporation is a diversified healthcare services company with 115,000 employees united around a common mission: to help people live happier, healthier lives. Through its subsidiaries, partnerships and joint ventures, including United Surgical Partners International, the Company operates general acute care and specialty hospitals, ambulatory surgery centers, urgent care centers and other outpatient facilities. Tenet's Conifer Health Solutions subsidiary provides technology-enabled performance improvement and health management solutions to hospitals, health systems, integrated delivery networks, physician groups, self-insured organizations and health plans.