Job added in hotlist
Applied job
Contract job
90-day-old-job
part-time-job
Recruiter job
Employer job
Expanded search
Apply online not available
View more jobs in Cranston, RI
View more jobs in Rhode Island
View Similar Jobs

Job Details

Compliance Analyst

Location
Cranston, RI

Apply for this job






2 hit(s)  

Profile

Description Compliance Specialist Conduent is the world's largest provider of diversified business process services with leading capabilities in transaction processing, automation, analytics and constituent experience. We work with both government and commercial customers in assisting them to deliver quality services to the people they serve.u00a0 We manage interactions with patients and the insured for a significant portion of the U.S. healthcare industry. We are the customer interface for large segments of the technology industry and the operational and processing partner of choice for public transportation systems around the world.u00a0 Whether it's digital payments, claims processing, benefit administration, automated tolling, customer care or distributed learning - Conduent manages and modernizes these interactions to create value for both our clients and their constituents. . Our project team provides direct and ongoing support to the Medicaid program in such areas health care purchasing, including contracts and agreements; health plan/provider oversight and monitoring; quality improvement, finance and actuarial support; business function support, including RIte Care member enrollment support and reconciliation; health plan performance review; health services utilization and data analysis; employer contact and enrollment for RIte Share; administrative/production support; and health policy and planning support, including federal regulatory analysis, waivers, and feasibility analyses of potential initiatives. This professional will assist the Compliance Manager in the overall development and conduct of the Compliance Oversight for Medicaid managed care and work to develop and sustain a robust compliance oversight program. Task areas will include integrating overall compliance oversight efforts with a focus on the following: Aid in the evaluation of each Medicaid Managed Care Organization (MCO) compliance program and contractual obligations regarding compliance and program integrity, including the solicitation, compiling and archive of the MCOsu2019 annual compliance plan and related requirements, and the analysis of all compliance policies and procedures, and annual work plan Assist in the management of the Medicaid MCO compliance and oversight, including the development of compliance audit metrics for site visits to the MCOs, participate in the site visits, the production of written findings, and the analysis of any follow-up documentation submitted by the MCOs Maintain current knowledge of changes in industry rules and regulations and assist in maintaining effective lines of communication with other departments to ensure these changes are disbursed appropriately. Ensure contracts, policies and procedures adhere to existing regulations Analyze Medicaid MCO quarterly compliance, appeals & grievances, informal formal complaint and fraud, waste, and abuse reports, including the statistical trending reports Support in the preparation for any CMS audits which may focus on Compliance related matters or managed Medicaid Program Integrity Participate in the development of associated reports for the 1115 Waiver and other external reports, including reports to the State Senate, Quality Strategy, External Quality Review, CMS quarterly reports,u00a0and ad-hoc reports as needed Monitor the appropriate regulatory and other bodies such as the Office of the Inspector General and Center for Medicare & Medicaid Services and communicate any new rules or actions established, including the interpretation of statute and promulgated regulations u00b7 Interact with and serve as a resource to the other Team members in the oversight and monitoring of Medicaid Managed Care Program Oversee day-to-day compliance inquiries regarding regulatory compliance Work with MCOs as directed to implement corrective action plans in situations of non-compliance, monitor progress and ensure completeness Qualifications: Recommended u00a0(minimum)Bacheloru2019s degree in health care related field (e.g. public health, health care administration, social work, nursing) required. Of additional interest would be certification in any of the following: CPHQ (Certified Professional in Healthcare Quality), CHDA (Certified Health Data Analyst), or CHC (Certified in Health Care Compliance). 3 years of progressive health care/medical industry, compliance and quality monitoring experience required Ability to think creatively. Ability to manage multiple projects simultaneously. Ability to work collaboratively as part of team to achieve client objectives; able to initiate and sustain successful working relationships with associates, community stakeholders and public and private agencies. Thorough knowledge of publicly financed health care delivery systems (e.g. Medicaid managed care; Medicare) services for persons with disabilities). Conduent is the world's largest provider of diversified business process services with leading capabilities in transaction processing, automation, analytics and constituent experience. We work with both government and commercial customers in assisting them to deliver quality services to the people they serve. We manage interactions with patients and the insured for a significant portion of the U.S. healthcare industry. We are the customer interface for large segments of the technology industry and the operational and processing partner of choice for public transportation systems around the world. Whether it's digital payments, claims processing, benefit administration, automated tolling, customer care or distributed learning - Conduent manages and modernizes these interactions to create value for both our clients and their constituents. Learn more at . Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.

Company info

Sign Up Now - ComplianceCrossing.com

Similar Jobs:
Fourth Party Risk and Compliance Specialist Analyst U.S. Bank • Providence RI Job #685866933 The Fourth Party Risk and Compliance Specialist (RCS) RCS Analyst will work within U.S. Bank’s Risk Management & Compliance Business Li...
Principal Regulatory Affairs Specialist
Location : Mansfield, MA
SUMMARY OF POSITION:Cardinal Health is seeking a Regulatory Affairs Specialist to support the Patient Care and Safety Regulatory Affairs team.  The selected candidate will provide regulatory support on a range of medical devices w...
Military Benefits Coordinator
Location : Cranston, RI
DescriptionAs a member of the Military Assistance Team within the Office of the Chairman, this position will be responsible for supporting CFG customers and internal business units in providing high level operational and service s...
The number of jobs listed on EmploymentCrossing is great. I appreciate the efforts that are taken to ensure the accuracy and validity of all jobs.
Richard S - Baltimore, MD
  • All we do is research jobs.
  • Our team of researchers, programmers, and analysts find you jobs from over 1,000 career pages and other sources
  • Our members get more interviews and jobs than people who use "public job boards"
Shoot for the moon. Even if you miss it, you will land among the stars.
ComplianceCrossing - #1 Job Aggregation and Private Job-Opening Research Service — The Most Quality Jobs Anywhere
ComplianceCrossing is the first job consolidation service in the employment industry to seek to include every job that exists in the world.
Copyright © 2018 ComplianceCrossing - All rights reserved. 169