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Under the direction of the Chief Compliance Officer, the Compliance Project Manager determines project objectives, establishes work priorities, and plans, directs and monitors project work with business areas. The position identifies project issues and potential roadblocks for escalation to the Compliance Officer and health plan leadership. The incumbent communicates to business teams on progress of critical path items. Relies on experience, healthcare and regulatory knowledge where possible and judgment to plan and accomplish goals. The Compliance Project Manager will gather and evaluate information concerning projects including research of regulatory requirements and deliverables, estimate and schedule project activities and coordinate meetings with business areas to drive projects to completion. Status of all active projects will be reported to the Compliance Officer and health plan leadership as required. Project work includes but is not limited to implementation of regulatory guidance, submission of required information and reports to regulatory entities and coordination of regulatory audit activities, with includes data requests, scheduling of auditors, coordination of interviews between auditors and business area leadership.
Serves as a project manager on Medicare Advantage related compliance projects and audits requiring coordination with the Centers for Medicare and Medicaid Services (CMS) regulatory entities and multiple business areas within the health plan.
Oversees assigned projects including monitoring project performance and compliance with applicable specifications, rules, regulations and laws related to business, managed care, regulatory entities including preparation of documentation necessary for delivery to business areas, regulatory entities and business area leadership.
Develops and maintains a working knowledge of the CMS regulatory entities that govern the Medicare Advantage line of business marketed by the health plan and their and associated requirements and guidance.
Researches regulations by reviewing regulatory bulletins, websites, REGTAP, Health Plan Management System memorandum and other sources of information.
Acts as a point of coordination for regulatory audits and assists with coordination of audit preparations and data submissions, scheduling of on-site audit interviews between auditors and business areas, development of responses to data requests, coordination of business responses to criticisms and post field work communication with regulatory entities regarding audit findings.
Keeps business areas abreast of requirements by researching the CMS regulatory, filing, and licensing information writing and communicating information to business areas.
Assist as required in the preparation of information to be submitted to regulatory entities.
Stays current on new and changing requirements of regulatory entities including but not limited to CMS, DHA, TDI, OSI, etc.
Develops and maintains an understanding of CMS regulatory reporting requirements and develops master list to ensure awareness by business areas and the Compliance Department.
Ensures deadlines for reports, submissions and documents to regulators are met.
Oversees receipt of regulatory communications, including logging, distribution and follow up with business areas to ensure an awareness of new and changing information and requirement.
May be called to convene meetings with business areas to develop plans to ensure the implementation of new and changing regulatory guidance.
Performs quality assurance functions during projects which include validating work effort and data, developing test plans and strategies, conducting detailed research and analysis.
Oversees projects to develop and implement large or complex projects affecting business processes over multiple interfacing areas within the health plan.
May be called on to assist with conducting risk assessments of business area processes to verify compliance with regulatory requirements.
Establishes schedules and methods for achieving project goals and objectives; and reviews work products, makes corrections and coordinates staff training and development efforts.
Relationship Management: Develops relationships with business areas. Develops working knowledge of regulatory requirements to support the Compliance Department's effort to serve a source of truth for regulatory and compliance matters.
Training: May be called on to support training efforts by the Compliance Department to for business areas regarding new and changing regulatory requirement or audit preparation.
Bachelor's degree in Healthcare Administration, Information Management, or a Business related field required.
Advanced knowledge of Microsoft Project.
Must have two to four years previous experience working within healthcare regulatory compliance, information technology or business project teams and in obtaining customer requirements and other analysis activities.
Previous experience managing projects of small to medium scope and complexity.Â
PMI Certification strongly preferred.
Certification in Healthcare Compliance (CHC) or similar preferred.
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.