Compliance - Coordinator 2

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Department

Compliance Operations

Job Summary

Job Description

• Acts as lead for all Dental Prepaid Ambulatory Health Plans (PAHP) relative to member denial notices.
• Acts as primary contact for all Dental PAHP issues relative to denial notices of prior authorized dental services.
• Effectively monitors and tracks changes to section 42 of the code of federal regulations (42 CFR) and rulemaking relative to Dental PAHP to identify potential impacts to the Legal Compliance auditing and review process.
• Creates and reviews internal reports to ensure all dental PAHP activities and projects remain on schedule and are completed within the required timelines and submitted to the Legal Compliance manager for review.
• Proactively organizes dental PAHP meetings, compiles meeting notes for distribution and tracks action items for follow-up and completion.
• Responsible for initiating onboarding and ongoing monitoring of all dental PAHPs.
• Acts as the Dental PAHP subject matter expert.
• Identifies training opportunities with internal and external stakeholders.
• Develops and manages Dental PAHP related training content of educational materials, dental specific denial notice templates, and desk manuals relative.
• Supports the Program Manager with delivery of all Dental PAHP trainings.
• Ensures that Dental PAHP member denial notices comply with federal, state, and contract requirements and are developed in accordance with established best practices, including in the spirit of the prior Wells v. Gee court mandate.
• Tracks and responds to all inquiries from the dental PAHPs timely and escalates to the Program Manager, when needed.
• Assists with ensuring all assigned Managed Care organizations (MCOs) are in compliance with the state contract, and all applicable federal and state laws, rules and regulations, and established through the monitoring and tracking mechanisms developed for legal compliance.
• Includes working directly with MCOs, contractors, and LDH Waiver and Behavioral Health agencies as needed; conducting mandatory recipient notice reviews;

and reviewing / formulating corrective action plans, reports, and relative documentation as deemed appropriate.

• Reviews assigned contractor deliverables for accuracy and completeness.
• Assists with designing and maintaining internal reports to ensure all monitoring activities remain on schedule and are completed within the required timelines.
• Conducts and participates in meetings, workgroups, public meetings, and other activities as directed.
• Records, prepares, and distributes meeting minutes and action items for assigned contractors, including dental PAHPs
• Assists the manager with maintaining updates to policies, procedures, and training manuals.
• Plans, coordinates, and executes communications related to compliance; includes written and verbal communications and communications with both internal and external stakeholders.
• Develops and manages all denial template revisions and template examples for MCOs, dental PAHPs and other contractors, as applicable.
• Acts as backup for the development and revisions to the Legal Compliance tasks calendar.
• Assists as backup for the internal Legal Compliance monthly metrics report.
• Takes the lead for reviewing, organizing, and coordinating LDH responses to requests from Disability Rights Louisiana with Program Manager's approval.
• Assists with the development and dissemination of Legal Compliance bulletins.
• Participates in the training of new staff.
• Assists with other projects as needed and performs additional duties as assigned.

QUALIFICATIONS

REQUIRED :

• Bachelor's degree or six years of professional work experience in lieu of degree.
• Minimum 1 year of professional experience working with federal / state healthcare programs, Medicaid Support, or related field.
• Proficient in the use of Adobe Acrobat Pro as well as Microsoft Office Suite (Word, Excel, PowerPoint, and Outlook).
• Strong analytical abilities, effective organizational and time management skills.
• Great attention to detail and follow up, and verbal / written communications skills.
• Works well both independently and as part of a team.
• Ability to set, follow, and meet deadlines.

DESIRED :

• Advanced degree.
• Minimum two years of experience working with federal / state / healthcare programs, Medicaid support, or related field.
• Minimum two years of professional experience with compliance and / or project management activity.
• Minimum one year of professional experience reviewing and editing written content for accuracy, and general proofing.
• Industry-related certifications.

Required Attachments

Please upload the following documents in the Resume / Cover Letter section.

• Detailed resume listing relevant qualifications and experience;
• Cover Letter indicating why you are a good fit for the position and University of Louisiana Systems;
• Names and contact information of three references;
• Diversity Statement (required for all Faculty positions and any Staff position of Assistant Manager and higher).

See Diversity Statement instructions by clicking this link :

Applications that do not include the required uploaded documents may not be considered.

Posting Close Date

This position will remain open until filled.

Note to Applicant :

Applicants should fully describe their qualifications and experience with specific reference to each of the minimum and preferred qualifications in their cover letter.

The search committee will use this information during the initial review of application materials.

References will be contacted at the appropriate phase of the recruitment process.

This position may require a criminal background check to be conducted on the candidate(s) selected for hire.

As part of the hiring process, applicants for positions at the University of New Orleans may be required to demonstrate the ability to perform job-related tasks.

The University of New Orleans is an Affirmative Action and Equal Employment Opportunity employer. We do not discriminate on the basis of race, gender, color, religion, national origin, disability, sexual orientation, gender identity, protected Veteran status, age if 40 or older, or any other characteristic protected by federal, state, or local law.