Health Plan Communication LiaisonAt — Regal Medical Group

Position Description

1. Establish relationships with health plan contacts & interface with Health Plans on any aspects of compliance requirements
2. Understand the underlying regulatory and delegated requirements, develops deep understanding of data and related business processes
3. Prepare Health Plan reports, workplans, identify and correct data issues prior to submission, submits reports in a compliance and timely manner.
4. Analyze data and utilize other internal reporting to – identify compliance issues, and work with business owners on development of internal corrective action plans
5. Prepares for audits, represents groups at audits and drive onsite and desktop audits.
6. Prepare and complete work plans for the assigned health plans
7. Works collaboratively with business units on identifying and closing compliance gaps and CAPs.
8. Work collaboratively with quality monitoring team to track the effectiveness of corrective actions.
9. Keep abreast with changes in legislation to act as a subject matter expert to the business.
10. Identifies policies/procedures and processes needing modification to meet new requirements or remediate gaps in compliance
11. Interface with HPN and compliance department to achieve optimal results
12. Maintains and tracks accurate and detailed documentation on requests and submission, and posts on department drive.
13. Proactively Identifies and escalates potential compliance issues
14. Maintain up to date departmental grids/dashboards/tools as required.
15. Works in a HIPPA compliant and timely manner.

Learning Objectives and Outcomes

• To inform the VP on how to improve mechanisms and pathways between inter-professional teams within the agency and community partners
• Create an evidence based mentoring program and creating a clear communication of instructions
• Ensure quality assurance at job reporting

Desired Qualifications

• 4 years University graduate required. Health Care Administration degree preferred.
• Minimum of two years of prior experience in healthcare environment required.
• Minimum 1- 2 year Data analysis or project management experience preferred.
• Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point).
• Must have excellent communications skills both verbally and written.
• Typing 60 words per minutes with accuracy. Knowledge of Excel, tables and pivot tables. Knowledge of Microsoft Access program preferred.
• Ability to deal with responsibility with confidential matters.
• Must have strong organization skills.
• Preparing for and representing the groups in audits, as well as handling other required interactions with assigned health plans and the business units of medical groups, tracking CAPs and effectiveness of corrective actions by working and communicating with quality monitoring team.
• Work with a high degree of independence, while seeking guidance when necessary and escalates issues to his/her immediate supervisor early.
• Ability to work in a multi-task, high stress environment.
• Must be able to handle multiple projects at one time, reset priorities day-to-day to meet deadlines, and know when to ask for assistance and direction when working with conflicting priorities.
• Must be self-motivated, pleasantly aggressive and realistically ambitious and have high personal ethics.
• Must have the ability to work with all levels of management and have the ability to develop positive working relationships with health plan auditors and company department heads.

Length of position: 3 months

Hours per week 40

Is this a paid opportunity? Yes

Hourly Rate $25.00

Application Instructions

Interview, resume