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Position Summary
 The Manager, USFHP Compliance will assist the Director, Compliance and Medicare Compliance Officer (MCO) in ensuring Martin’s Point (MP) US Family Health Program (USFHP) products, service offerings, internal technology, and its delegated entities and vendors are fully compliant with the Defense Health Agency (DHA), State regulations, licensure requirements in the states in which it operates and all other applicable Federal regulations. Under the direction of the Director, Compliance, the position will support the oversight and management of the compliance program by performing the key outcomes below.
Job Description

Key Outcomes:

Maintains proficiency with TriCare Manuals and sub-regulatory guidance in support of the USFHP productWorks with the Director to create and maintain an effective compliance plan including processes for the review, analysis and stratification of compliance risks and issuesMaintains effective business relations with the Defense Health Agency, their designated contractors, third-party regulators and business partners, vendors, and delegatesProvides routine updates regarding compliance performance, concerns and risks to the Director, or other leadership as appropriate, including supporting technical and analytical information as neededDevelops and oversees a compliance SMEs integral in the delivery of a USFHP regulatory compliance education plan to be delivered to applicable MP employeesLeverages risk assessment processes to assist the Director in establishing audit and work plans, monitoring compliance risk areas across the organization, and amending the audit schedule as risk issues are identifiedConducts or supports investigations and remediation processes that include collaboration with operational business departments, to ensure prompt response to any action inconsistent with applicable regulatory requirements or Martin’s Point business practices, including reporting to DHA, when applicableAssists the Director in the creation, maintenance and implementation of policies, procedures, compliance documents, and training materialsSupports and/or leads internal and external auditsProvides support for staff involved in investigating Fraud, Waste and Abuse (FWA) allegations received via the hotline and other reporting mechanisms. Ensuring reporting to DHA, when requiredProvides oversight and direction for staff involved in investigating Congressional complaints regarding the USFHP line of business. Ensuring outreach to applicable parties (enrollees, providers, etc.) to obtain additional information and/or provide resolution and root cause analysis to identify opportunities for improvements and work with cross-functional teams as applicableServes as the primary point of contact for the Defense Health AgencyLeads and coordinates DHA site visits, operational conferences, and auditsRepresents Martin’s Point at applicable Alliance committees, workgroups, conferences, and strategic discussionsPrepares internal business partners, vendors, and delegates for DHA audits to ensure the best possible outcomesProvides compliance support and guidance to the Quality team to ensure successful NCQA audit preparation and executionEnsures completion of deliverables within required timeframes

Education/Experience:

Bachelor’s degree required or equivalent combination of education and work experience in a relevant field5+ years of TRICARE and Defense Health Agency experience required, including a focus of leadership experience in related product line(s)Prior experience with DHA audits requiredPrevious Compliance, Integrity, FWA or directly related experience preferred

Skills/Knowledge/Competencies (Behaviors):

Excellent interpersonal, verbal and written communication skillsStrong project management skillsApproaches work assignments in an organized, process-focused manner, which fosters the achievement of effective resultsCritical thinking:  can identify root causes and implement creative solutionsAbility to prioritize time and tasks efficiently and effectively for self and othersAbility to prioritize and manage multiple competing demandsAbility to function independentlyStrong management and leadership skills; ability to prioritize time and tasks efficiently and effectively for self and others, manage multiple competing demandsProficient user of Microsoft Office Applications (e.g. Word, Excel, Visio, Project, PowerPoint, and Access)Exceptional verbal and written communicationDemonstrable knowledge of Medicare guidelines, audit protocols and processes requiredBroad and detailed knowledge of Tricare, USFHP, and health plan operations and best practices preferredDemonstrable ability to convey complex information in a meaningful way to a variety of audiences requiredAbility to translate regulatory requirements to business and/or technical system requirements

We are an equal opportunity/affirmative action employer.

Do you have a question about careers at Martin’s Point Health Care? Contact us at: jobinquiries@martinspoint.org