Conduent Compliance Specialist in Cranston, Rhode Island

Compliance Specialist

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.

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 www.conduent.com .

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 MCOs’ 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, and 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

  • 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 (minimum)

Bachelor’s 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 www.conduent.com .

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. People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form at https://downloads.conduent.com/content/usa/en/file/conduent-applicant-adaaa-referral-form.pdf .

Job Project Management

Primary Location United States-Rhode Island-Cranston

Organization Government

Unposting Date Ongoing

Req ID: 18011830