Manager, USFHP Compliance - Remote

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond.  As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community.  Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day.  Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.
 

Key Outcomes:

• Maintains proficiency with TriCare Manuals and sub-regulatory guidance in support of the USFHP product
• Works with the Director to create and maintain an effective compliance plan including processes for the review, analysis and stratification of compliance risks and issues
• Maintains effective business relations with the Defense Health Agency, their designated contractors, third-party regulators and business partners, vendors, and delegates
• Provides routine updates regarding compliance performance, concerns and risks to the Director, or other leadership as appropriate, including supporting technical and analytical information as needed
• Develops and oversees a compliance SMEs integral in the delivery of a USFHP regulatory compliance education plan to be delivered to applicable MP employees
• Leverages risk assessment processes to assist the Director in establishing audit and work plans, monitoring compliance risk areas across the organization, and amending the audit schedule as risk issues are identified
• Conducts or supports investigations and remediation processes that include collaboration with operational business departments, to ensure prompt response to any action inconsistent with applicable regulatory requirements or Martin’s Point business practices, including reporting to DHA, when applicable
• Assists the Director in the creation, maintenance and implementation of policies, procedures, compliance documents, and training materials
• Supports and/or leads internal and external audits
• Provides support for staff involved in investigating Fraud, Waste and Abuse (FWA) allegations received via the hotline and other reporting mechanisms. Ensuring reporting to DHA, when required
• Provides oversight and direction for staff involved in investigating Congressional complaints regarding the USFHP line of business. Ensuring outreach to applicable parties (enrollees, providers, etc.) to obtain additional information and/or provide resolution and root cause analysis to identify opportunities for improvements and work with cross-functional teams as applicable
• Serves as the primary point of contact for the Defense Health Agency
• Leads and coordinates DHA site visits, operational conferences, and audits
• Represents Martin’s Point at applicable Alliance committees, workgroups, conferences, and strategic discussions
• Prepares internal business partners, vendors, and delegates for DHA audits to ensure the best possible outcomes
• Provides compliance support and guidance to the Quality team to ensure successful NCQA audit preparation and execution
• Ensures completion of deliverables within required timeframes

Education/Experience:

• Bachelor’s degree required or equivalent combination of education and work experience in a relevant field
• 5+ years of TRICARE and Defense Health Agency experience required, including a focus of leadership experience in related product line(s)
• Prior experience with DHA audits required
• Previous Compliance, Integrity, FWA or directly related experience preferred

Skills/Knowledge/Competencies (Behaviors):

• Excellent interpersonal, verbal and written communication skills
• Strong project management skills
• Approaches work assignments in an organized, process-focused manner, which fosters the achievement of effective results
• Critical thinking:  can identify root causes and implement creative solutions
• Ability to prioritize time and tasks efficiently and effectively for self and others
• Ability to prioritize and manage multiple competing demands
• Ability to function independently
• Strong management and leadership skills; ability to prioritize time and tasks efficiently and effectively for self and others, manage multiple competing demands
• Proficient user of Microsoft Office Applications (e.g. Word, Excel, Visio, Project, PowerPoint, and Access)
• Exceptional verbal and written communication
• Demonstrable knowledge of Medicare guidelines, audit protocols and processes required
• Broad and detailed knowledge of Tricare, USFHP, and health plan operations and best practices preferred
• Demonstrable ability to convey complex information in a meaningful way to a variety of audiences required
• Ability to translate regulatory requirements to business and/or technical system requirements

We are an equal opportunity/affirmative action employer.

Do you have a question about careers at Martin’s Point Health Care? Contact us at: jobinquiries@martinspoint.org