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Henry Ford Health System Government Programs Consultant - Health Alliance Plan in Troy, Michigan

GENERAL SUMMARY:

Lead in the coordination of operational compliance activities and provide guidance, instruction and direction under minimal supervision. Participate in compliance oversight for all departments within the Provider Operations division, perform monthly audits to ensure performance levels are maintained and work in conjunction with division leadership to ensure Centers for Medicare and Medicaid Services (CMS), State of Michigan, and National Committee for Quality Assurance (NCQA) regulatory guidelines are adhered to. Act as the compliance lead and subject matter expert on Government programs rules and regulations. Assist Provider Operations business areas in identifying compliance requirements, assessing risks, and recommending compliant solutions that support business goals. Provide guidance to leaders, individual employees and first tier, downstream and related entities (FDR’s) on corrective action plans for identified compliance issues and track completion.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

  • Collaborate with Provider Operations department leaders, vendor management, information technology, corporate compliance and all associated FDR’s to ensure activities adhere to CMS, State of Michigan and NCQA guidelines where applicable.

  • Assist leaders with the implementation of Government program regulations and validate compliance during on-going evaluation and reviews.

  • Conduct analysis and create written reports to monitor compliance and track performance against regulatory standards, including internal and external regulatory audits.

  • Review and interpret new and existing Government programs regulations and coordinate with plan Medicaid, Medicare and legal staff to provide opinions on compliance issues.

  • Investigate compliance issues to resolve complex problems and make recommendations to business leaders and employees to ensure on-going compliance.

  • Identify trends and patterns of non-compliance and recommend areas for intervention and improvement.

  • Coordinate with Provider Operations business areas and FDR’s on the implementation and completion of corrective action plans when needed.

  • Coordinate with division educators on all compliance-related remediation training and implementation of any newly established health plan compliance requirements.

  • Act as divisional SME on all regulatory audits and perform quality assurance on claim universes generated for audit purposes.

  • Perform other duties as assigned.

EDUCATION/EXPERIENCE REQUIRED:

+ + Bachelor's Degree in related field required.

  • Minimum three (3) years in related health care field which may include experience in compliance, audit and/or business area specific compliance oversight required.

  • Minimum two (2) years in reading, analyzing and interpreting State and Federal rules and regulations required.

  • Master's Degree in related field preferred.

  • Relevant experience in the oversight of CMS and/or State of Michigan regulatory requirements preferred.

  • Project Management experience preferred.

    Overview

    Under the leadership of President and CEO Wright L. Lassiter, III, Henry Ford Health System is a

    $6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites

    including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and

    other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system

    now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one

    of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the

    health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s

    major academic medical centers, receiving between $90-$100 million in annual research funding and

    remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical

    education and training, the health system has trained nearly 40% of physicians currently practicing

    in the state and also provides education and training for other health professionals including nurses,

    pharmacists, radiology and respiratory technicians. visitHenryFord.com.

    Benefits

    Whether it's offering a new medical option, helping you make healthier lifestyle choices or

    making the employee enrollment selection experience easier, it's all about choice. Henry

    Ford Health System has a new approach for its employee benefits program - My Choice

    Rewards. My Choice Rewards is a program as diverse as the people it serves. There are

    dozens of options for all of our employees including compensation, benefits, work/life balance

    and learning - options that enhance your career and add value to your personal life. As an

    employee you are provided access to Retirement Programs, an Employee Assistance Program

    (Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness, and a whole host of other benefits and services. Employee's classified as contingent status are not eligible for benefits.

    Equal Employment Opportunity/Affirmative Action Employer

    Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is committed to the hiring, advancement and fair treatment of all individuals without regard to race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height, weight, marital status, family status, gender identity, sexual orientation, and genetic information, or any other protected status in accordance with applicable federal and state laws.
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