Medicare Advantage Compliance Coordinator-Full Time Days
City/State: Fredericksburg, Virginia
Category: Support Services
Position Hours: 40Apply
Job Requisition Number: R-3539
Job Department: 9109901 MWHP-Corporate
Job Posted Date: Jun 08, 2021
Start the day excited to make a difference…end the day knowing you did. Come join our team.This position is accountable for providing support to the Mary Washington Health Plan Compliance Program. This position must demonstrate a commitment of quality service to our members, the public and our co-workers. This position must also consistently support the mission, vision, and values of Mary Washington Healthcare.
- Performs routine compliance monitoring to include:
- Reviews reports to verify enrollment requests are processed in a timely manner
- Monitors compliance hotline and performs test calls/test emails to verify process is working as expected
- Monitors network adequacy by reviewing reports to verify network adequacy meets CMS requirements
- Confirms the accuracy of internal and external contact information submitted to CMS
- Reviews published provider directories to validate the accuracy of published information
- Conducts monthly OIG/GSA/OFAC exclusion screening
- Provides administrative meeting support for the Compliance Committee and monthly CMS Account Manager Meetings. This includes maintaining and organizing data reported to the Compliance Committee and the CMS Account Manager.
- Reviews health plan call logs to identify trends, ensure appropriate categorization and escalate identified concerns to compliance leadership.
- Assists in submission, review, and organization of marketing materials. Tracks submission, stores, and organizes marketing materials.
- Other duties as assigned
- High school graduate or equivalent with some college preferred.
- Proficient interpersonal, writing, and other communication skills required.
- Working knowledge of basic computer skills to include word processing, spread sheets, electronic calendars, database management, graphics, presentations, and Internet communications.
As an EOE/AA employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.