Contract Compliance Coordinator Job at The Health Plan of West Virginia Inc
Under the direction of the VP of MHT Contract Compliance, the MHT Contract Compliance Coordinator will assist the VP with oversight of all MHT contract obligations to maintain compliance with the State Medicaid and CHIP programs. The Liaison shall assist with report development and auditing, financial data analysis, monitoring changes in State and Federal regulation that could impact The Health Plan, subcontractor monitoring and additional services as needed.
Required:
- Bachelor's degree or at least two (2) years of Government Program experience, Health Care Management, or related field.
- Prior experience with contract management and report development;
- Data analytics skills, with ability to review data sets, interpret output and summarize results;
- Ability to evaluate and analyze regulation;
- Knowledge in Microsoft Office programs;
- Must be able to work on multiple projects concurrently;
- Must have excellent organizational and leadership skills, with ability to work independently.
Desired:
- Knowledge of WV Medicaid/CHIP programs or familiarity with policies and regulations governing programs;
- Strong communication skills, verbal and written.
Responsibilities:
- Work/coordinate with different teams within the organization to ensure MHT contract deliverables are met;
- Assist with oversight and monitoring of subcontractors and vendors to ensure compliance with contractual obligations;
- Assist with report development, report oversight and report submission;
- Research and Review State and Federal Medicaid and CHIP regulations;
- Audit/monitor various activities, functions and reports for accuracy and compliance;
- Assist with annual rate (premium) development/review process, including data analysis of materials provided by both internal and external parties;
- Assist with reviewing claims data to determine opportunities for policy amendment, provider contract innovation, or payment issues;
- Assist with development of member and provider materials (e.g. Member Handbook);
- Work with the WV Department of Health and Human Resources on reporting, contract updates and other requests received by the State;
- Assist with reviewing monthly eligibility and payment files to identify errors needing remediated.
Job Type: Full-time
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