Coord Plan Compliance
This position will support PA Compliance and Privacy and PA State Regulatory Affairs and Assists with the implementation, maintenance and monitoring of the Plan Compliance Program for the physical health managed care business.
This position may generally be responsible for performing some administrative tasks such as:
Scheduling meeting, attending meetings, and taking meeting minutes, and order office supplies.
Monitoring the Department cost center and presenting monthly variance reports to management.
Collaborating with team members to ensure timely updates are made to departmental policies and procedures and standard operating procedures.
Maintains historical database of all policies and procedures and Standard Operating Procedures.
Maintaining the Department's various SharePoint sites, adding documents as needed and ensuring that information on the site is accurate and up to date.
Assisting with special projects.
The PA Compliance and Privacy and PA Regulatory Affairs responsibilities may include Identifying and summarizing PA Bulletins for distribution to key internal stakeholders on a weekly basis.
Preparing and presenting quarterly report at PA Regulatory Compliance and Privacy Committee.
Managing the process to obtain access to state Systems for key internal stakeholders, including addressing all questions and issues and serving as the liaison with DHS on state access concerns.
Conducting quarterly audits to ensure appropriate access to systems and terminated employees access is removed by DHS.
Processing and distributing provider preclusion notices and maintaining accurate records of all notices.
Submitting BPI provider referrals to the BPI via DocuShare and maintain accurate and complete records.
Submitting member recipient restriction letters to BPI via DocuShare and maintain accurate and complete tracking of all records pertaining to recipient restriction, including but not limited to Continuations, Proposed Restrictions, Lifts, Voluntary Restrictions, and Fraudulent Prescriptions.
Upload approved letters to the DHS secure website.
Assisting with BPI Retrospective Reviews and respond to all ad hoc requests to retrieve medical records from the Department of Human Services secure website.
Monitoring the PA Compliance Mailbox daily and confirming that all inquiries are assigned for follow up.
Downloading and reviewing Compliance Dashboard reports and alerting key staff of issues potentially requiring follow-up.
Education/
Experience:
High School/GED Bachelor's Degree preferred 3 to 5 years office experience, in a healthcare setting preferred.
Other Skills Proficiency with Microsoft Office Suite (Word, Excel, Power Point).
Familiarity with SharePoint.
Self-starter who can work independently and is detail oriented.
Recommended Skills Auditing Databases Health Care Maintenance Managed Care Medical Records Estimated Salary: $20 to $28 per hour based on qualifications.
This position may generally be responsible for performing some administrative tasks such as:
Scheduling meeting, attending meetings, and taking meeting minutes, and order office supplies.
Monitoring the Department cost center and presenting monthly variance reports to management.
Collaborating with team members to ensure timely updates are made to departmental policies and procedures and standard operating procedures.
Maintains historical database of all policies and procedures and Standard Operating Procedures.
Maintaining the Department's various SharePoint sites, adding documents as needed and ensuring that information on the site is accurate and up to date.
Assisting with special projects.
The PA Compliance and Privacy and PA Regulatory Affairs responsibilities may include Identifying and summarizing PA Bulletins for distribution to key internal stakeholders on a weekly basis.
Preparing and presenting quarterly report at PA Regulatory Compliance and Privacy Committee.
Managing the process to obtain access to state Systems for key internal stakeholders, including addressing all questions and issues and serving as the liaison with DHS on state access concerns.
Conducting quarterly audits to ensure appropriate access to systems and terminated employees access is removed by DHS.
Processing and distributing provider preclusion notices and maintaining accurate records of all notices.
Submitting BPI provider referrals to the BPI via DocuShare and maintain accurate and complete records.
Submitting member recipient restriction letters to BPI via DocuShare and maintain accurate and complete tracking of all records pertaining to recipient restriction, including but not limited to Continuations, Proposed Restrictions, Lifts, Voluntary Restrictions, and Fraudulent Prescriptions.
Upload approved letters to the DHS secure website.
Assisting with BPI Retrospective Reviews and respond to all ad hoc requests to retrieve medical records from the Department of Human Services secure website.
Monitoring the PA Compliance Mailbox daily and confirming that all inquiries are assigned for follow up.
Downloading and reviewing Compliance Dashboard reports and alerting key staff of issues potentially requiring follow-up.
Education/
Experience:
High School/GED Bachelor's Degree preferred 3 to 5 years office experience, in a healthcare setting preferred.
Other Skills Proficiency with Microsoft Office Suite (Word, Excel, Power Point).
Familiarity with SharePoint.
Self-starter who can work independently and is detail oriented.
Recommended Skills Auditing Databases Health Care Maintenance Managed Care Medical Records Estimated Salary: $20 to $28 per hour based on qualifications.
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