Managed Health Services (MHS) · 1 day ago
Business Compliance Consultant
Indiana, United States
Full-time
Hybrid
Mid, Senior Level
$88K/yr - $158K/yr
7+ years expManaged Health Services (MHS) is transforming the health of communities, one person at a time. The Business Compliance Consultant will work closely with various teams to ensure compliance with state and federal health care laws, manage contracts, and participate in hearings and audits.
Health Care
Responsibilities
Conduct the review of and make changes to product-specific contracts and amendments between Health Plan and Material Subcontractors
Remain up to date on all state and federal health care laws, including laws applicable to managed care industry, and on all IN Medicaid contracts and amendments
Perform legal research and prepare memoranda regarding legislative or regulatory changes affecting the company’s vendor and/or health care provider contracts
Coordinate SIU waste and abuse efforts with the Corporate SIU Team
Complete all research on and file preparation for State Fair Hearings between Health Plan and State Regulatory Agency. Represent MHS at all State Fair Hearings. Track all outcomes and provide reports to Senior Leadership on outcomes. Collaborate with cross-functionally to remedy MHS process issues
Identifies issues with questionable billing providers and vendor contracts. Tracks trends for department use and Corporate Compliance. Escalates as required to senior management
Coordinates department preparation for State Fair Hearings and Questionable Provider Audits (building case files, universes, evidence of compliance and other documentation as needed)
Completes all required compliance training
Participate in implementation of regulatory changes that span multiple departments, as needed
Provide support and input into the development and maintenance of a consistent process for identification and escalation of issues and supporting tools; may participate in the implementation of a tool(s) for maintenance of mapping requirements/regulations to policies and procedures (P&Ps) and owners (i.e. CFR owners)
Participate in developing and maintaining consistent processes/methods for development, implementation, communication and training on new/updated policies and procedures
Participate with Business Units/departments with an end-to-end process orientation to ensure appropriate connectivity and handoffs are built into P&Ps that span multiple departments
Participates in and supports other programs such as privacy and security (including HIPAA program), Ethics & Privacy, Fraud Waste & Abuse, Code of Conduct, etc
Performs other duties as assigned
Qualification
Required
BA degree in Business Administration, Finance or related field
Five to ten years experience in progressively broad and challenging roles in a given operational area
Prior experience in a compliance-related role highly desirable
7+ years of combined contract drafting and legal research experience
Knowledge of the health care industry, specifically government services and applicable laws and regulations
Advanced knowledge of Indiana Medicaid insurance, Indiana Administrative Code and Code of Federal Regulations preferred
Benefits
Health insurance
401K
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Company
Managed Health Services (MHS)
Managed Health Services (MHS) is a managed care entity that has been proudly serving Hoosiers for more than two decades through the Hoosier Healthwise (HHW) and Hoosier Care Connect Medicaid programs and the Healthy Indiana (HIP) Medicaid alternative program.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Kevin OToole
Chairman, President and CEO
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