What are the responsibilities and job description for the Director, Contract Compliance MHT position at The Health Plan (THP)?
Position Summary
The MHT Director, Contract Compliance and Administration, is responsible for the overall delivery of the WV Medicaid/WVCHIP Mountain Health Trust managed care contract with the WV Bureau for Medical Services (BMS). The Director is responsible for meeting as needed with BMS, legislators, other government bodies, community partners and other stakeholders, as necessary. The Director must maintain a positive client relationship, provide timely and informed responses to operational and administrative inquiries, and ensure compliance with all MHT contractual deliverables, including but not limited to, standard reporting requirements.
Qualifications Required
The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.
8:00am-5:00pm
40
The MHT Director, Contract Compliance and Administration, is responsible for the overall delivery of the WV Medicaid/WVCHIP Mountain Health Trust managed care contract with the WV Bureau for Medical Services (BMS). The Director is responsible for meeting as needed with BMS, legislators, other government bodies, community partners and other stakeholders, as necessary. The Director must maintain a positive client relationship, provide timely and informed responses to operational and administrative inquiries, and ensure compliance with all MHT contractual deliverables, including but not limited to, standard reporting requirements.
Qualifications Required
- The Administrator must possess professional experience in health care, managed care, or health services administration and meet the following requirements: Bachelor’s degree with a minimum of four (4) years’ professional experience and two (2) years’ experience in health care contracting; or Master’s degree with a minimum of three (3) years’ professional experience and one (1) year experience in health care contracting; and
- Experience working with Medicaid and/or CHIP populations;
- Must be able to evaluate and analyze regulations;
- Must be able to interpret regulations and make policy recommendations to ensure compliance;
- Knowledge in Microsoft Office programs;
- Must be able to work on multiple projects concurrently;
- Must have excellent organizational and leadership skills, works independently and has the ability to interact well with others;
- Valid driver's license;
- Must be based in West Virginia, preferably Charleston.
- Knowledge in current policies and regulations related to Medicaid;
- Strong oral communication skills and the ability to write clearly and effectively;
- Knowledge of HEDIS measures and NCQA accreditation standards.
- Work with various teams in ensuring contract deliverables are completed accurately and on time;
- Oversee and monitor subcontractors and vendors based upon agreed upon contract terms and requirements with BMS contract and other applicable contracts;
- Coordinate on member appeal process;
- Review and research State and Federal regulations;
- Review and analyze State Plan Amendments to determine impact on operational processes;
- Provide contract compliance support for EQRO and NCQA;
- Audit/monitor various activities/functions/reports for accuracy and contract compliance;
- Responsible for completion/updates for required contractual documents such as Member Handbook;
- Responsible for development and modifications to policies and procedures related to contract requirements/compliance;.
- Assist SVP in implementing new lines of businesses related to Government Programs;
- Assist with efforts of Community Outreach Liaison(s);
- Assist with Member Advisory Committee and other ad hoc committees/meetings that actively inform the Department's community and stakeholder engagement goals;
- Pursue strategic initiatives or pilots and bring these to fruition by partnering with the Marketing, Clinical, Quality and/or Provider Delivery Services Departments;
- Cultivate relationships with key not-for-profit, academic and government/elected officials to proactively anticipate policy, legislative or regulatory changes impacting managed care organizations at the state and federal level;
- Collect information to contribute to strategic planning and design of Medicaid/WVCHIP value-adds or potential optional benefits of interest to members.
The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.
8:00am-5:00pm
40