Job Description

At Memorial Hermann, were about creating exceptional experiences for both our patients and our employees. Our goal is to provide opportunities for our diverse employee population that develop and grow careers in a team-oriented environment focused on patient care.

Every employee, at every level, begins their journey at Memorial Hermann learning about the history of the organization and its established culture built on trust and integrity. Our employees drive this culture, and we want you to be a part of it.

Job Summary

The Compliance Monitoring Analyst is responsible for compliance oversight for Medicare and related products, in order to ensure effectiveness in meeting CMS regulatory requirements and procedural processes. Assess, analyze, and improve the effectiveness and efficiency of governance, financial and operational control processes, offers recommendations to improve operations, and assist with enterprise risk and compliance activities.
Monitors and oversees state and federal regulations changes and the implementation of new legislation. Works closely with all areas of business on the development of policy, provides regulatory guidance and manages the contractual and regulatory relationship with governing agencies. Typically reports to Delegation Oversight Manager.

Job Description

Minimum Qualifications

Education: Bachelors Degree required

Licenses/Certifications: (None)

Experience / Knowledge / Skills:

* Three (3) or more years in Medicare Advantage or Part D plan operations, prior compliance monitoring experience within a Medicare or other insurance health plan, drug plan, or PBM a plus
* Experience planning and drafting monitoring study designs, implementing monitoring studies, correlating and presenting findings
* Experience identifying and overcoming barriers to completion of a monitoring study, and to work through issues that may arise
* Possess competency and experience in the areas of risk management, business and operational processes, internal auditing, and other internal controls, and regulatory compliance
* Knowledgeable and compliant with all relevant laws, rules regulations and accreditation standards and requirement
* Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas
* Organizational skills with the ability to handle multiple tasks and/or projects at one time
* Customer service skills with the ability to interact professionally and effectively with delegates, internal business partners and staff from all departments within and outside the company
* Decision-making skills with the ability to investigate and weigh alternatives and select the course of action that provides the greatest benefit to the organization
* Problem solving skills with the ability to look for root causes and implementable, workable solutions
* Interpersonal skills with the ability to work in a fast-paced environment and participate as an independent contributor with little supervision or as an active team member depending on the situation and needs
* Proficient with Microsoft Applications: Word, Excel, PowerPoint, Access and Outlook; ability to navigate a Windows based environment
* Ability to travel
* Demonstrates commitment to the Partners-in-Caring process by integrating our culture in all internal and external customer interactions; delivers on our brand promise of we advance health through innovation, accountability, empowerment, collaboration, compassion and results while ensuring one Memorial Hermann.

Principal Accountabilities

* Conductsoversightactivities, monitorsrootcauseanalysis for noteddeficiencies, conducts oversight activitiespreparation of reportsindicating the results of monitoring efforts. Enforces andmanagesremediationplanswhen deficiencies are identified.
* Conducts ongoingmonitoringand promote thecomplianceofMedicareAdvantage(PartC)andPrescription Drug (Part D) plan delegatedoperations in meeting the requirements established by Federalagencies,primarilytheregulationsand program guidance setforth by theCentersforMedicareandMedicaidServices(CMS).
* Routinely monitorvariousfunctionswithin Delegates activitiesvalidatingadherence to remediation plans wheredeficiencies are foundandpromoting adherence to new and/orupdated regulatory requirements. Additionally, Analyst will be responsible for monitoring any reporting provided by Delegate to validate adherence to contractual and CMS obligations.
* Assists delegated entities in maintainingcompliance by making recommendations,basedon monitoring results, for improvementand facilitating training or work groups as needed. Conducts periodicmonitoringandauditingactivities to identifyandassess areas of compliance riskandrecommendopportunitiesforimprovement.
* Maintain monitoringtools by creatingstandardized forms using informationidentified by regulatoryagenciesmonitoringelementsanddepartmentalpoliciesandprocedures.Increaseawarenessofmonitoringprotocolsthroughaccurate & timely reporting.
* Monitors, tracks and documents subcontractor performance through completion of Pre-delegation, Ad-Hoc and Annual Delegation audits.
* Manages and monitors routine and recurring subcontractor performance monitoring of reports.
* Partners with business owners and vendors to review escalated issues or concerns associated with subcontractor performance and internal business areas where suspected and confirmed non-compliance is identified or reported.
* Maintains and tracks whether the subcontractors submit timely and accurate deliverables required by state and federal regulations including both routine/recurring reports and ad hoc requests.
* Assists Compliance Manager with delegation assessments as necessary to comply with state (TDI), federal (CMS), NCQA, and any other applicable requirements.
* Participates in quarterly and ad-hoc subcontractor oversight meetings with designated business leads to report on oversight activities and identified non-compliance.
* Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
* Assumes responsibilityforpromoting to theParts C and D operational departments andprovidersthehighestlevel of regulatorycompliance and service delivery formembers.
* Supports implementation and maintenanceofthe Corporate ComplianceProgram.
* Communicate, collaborate and cooperate with internal and external stakeholders.
* Adheres to all Compliance/Program Integrity requirements.
* Complies with HIPAA Regulations
* Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
* Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
* Other duties as assigned.