Compliance Consultant – Program Integrity - Kansas
January 10, 2018
Overland Park, Kansas
Bring us your experience, your head for strategy, your strength with relationships and your eye for opportunity. In return we offer an unmatched place to grow and develop your career among a richly diverse group of businesses driven by the power and stability of a leading health care organization. Come help us heal and strengthen the health care system as you do your life's best work. UnitedHealthcare Community & State, part of the UnitedHealth Group family of companies, is looking for an experienced Health Plan Program Integrity / Fraud, Waste and Abuse Compliance Consultant to join our dynamic Compliance team. The Compliance Consultant is an individual contributor role responsible for fraud, waste and abuse and specific research leading to best practice policy implementation and vendor monitoring to drive problem/process resolution for the Kansas Medicaid health plan. Ideal candidates will have experience in a health care FWA, regulatory, or compliance role, will have experience working with state regulators, including Medicaid Fraud Control Units, and will have strong project management experience and experience working in a matrixed environment. Primary Responsibilities:Works to ensure that internal processes are executed, especially related to intersegment responsibilities for fraud, waste, and abuse (FWA) vendors' instances of health care FWA by medical profession or insured memberActs as FWA subject matter expert for Federal and local FWA regulations and subsequent regulatory policy and process implementationResponsible for keeping apprised of current, proposed, and new federal and state regulations / guidelinesEnsures that changes in requirements are included in education and carried out by required audiencesServes as health plan FWA trainer. Coordinates and supports implementation of FWA training and educational programs with the appropriate business areas and vendorsAs necessary, gather and analyze all information and documents related to a FWA investigationActs as health plan FWA vendor liaison, i.e., conducts reviews on policies to make sure they are compliant; ensures that vendor processes are executed appropriately; that timelines are met per regulatory fulfillment; sets boundaries for vendors so that accountabilities are clearServes as regulatory FWA liaison to the regulatory entities and internally to key FWA organizational partners, including participation in meetings with regulatorsActs as a backup to Compliance Director to ensure that timelines and requests for information are metDevelops and maintains fraud-related policies, e.g., documents the education and hand-offs for the health plan from functional teams as required to meet contractual obligationsOversees and ensures all required FWA regulatory reporting meets regulatory expectationsEnsures procedures are established to support timely communication and education regarding the fraud programEnsures that procedures are in place to review and report possible violations in accordance with the reporting requirements as outlined in the FWA Plan. Reviews vendors to make sure that all aspects of FWA are managed and policies are developed where gaps are identified
Required Qualifications:2+ years of experience in a FWA, investigations, regulatory or compliance role, or related experience2+ years of experience working in a government, healthcare, managed care or insurance environment, or related experienceProven record of ability to translate highly complex concepts in ways that can be understood by a variety of audiencesAbility to identify root cause issues and ensure appropriate corrective actionIntermediate or better proficiency using MS Word, MS Excel and MS PowerPointMust live within Kansas Preferred Qualifications:Bachelor's degree or equivalent experience2+ years of experience auditing medical billing and codingDemonstrated ability to communicate effectively in written and verbal EnglishAbility to manage multiple projects and multiple relationships across the matrixAbility to stay organized and use time management skillsAbility to work effectively and congenially with employees at all levelsObjective, collaborative approach; relationship builder who strives to build partnerships Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: St. Lawrence, Overland Park, KS, Kansas, FWA, investigations, regulatory, compliance, legal, JD, government, health care, managed care
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.