Sales Compliance Specialist

About NYC Health + Hospitals

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

The Sales Compliance Specialist reports to the Chief Growth Officer. The Sales Compliance Specialist will support the oversight and management of Sales Department regulatory compliance activities, including monitoring of all related regulatory guidance for compliance work plan activities, supporting the department with corrective actions and regulatory disclosures, contributing to the annual Compliance risk analysis and Work Plan, and ensuring the Sales Department regulatory-related trainings are accurate and updated. 

Job Description

• Contributes to the annual risk assessment and work plan, ensuring the gathering and provision of Sales Department regulatory compliance related information.
• Supports the regular development and review of Sales Department regulatory compliance policies and procedures and its related activities for the Marketplace, Medicare, and MLTC/MAP lines of business.
• Conducts auditing and monitoring activities for Marketplace, Medicare, and MLTC/MAP as outlined in Compliance Work Plan.
• Contributes quality and timely data for the materials prepared for both the Internal Compliance Committee Meetings and Audit and Compliance Subcommittee of the Board of Directors.
• Synthesizes regulatory guidance into compliance activities, tracking related due dates, and providing support to business areas completing deliverables.
• Upon identification of non-compliance, provide support to the Sales Department in conducting a root cause analysis and corrective actions, including guidance on methodology, identification of relevant regulatory requirements and any regulatory compliance context, and compliance review. Plays a critical role in driving the progress for corrective actions throughout the organization.
• Coordinates the support for Sales Department in creating and updating monitoring metrics to assess continued compliance with regulatory requirements.
• Ensures proper investigation of all Sales Department regulatory compliance-related issues.
• Creates and leads employee training programs for Sales Department compliance-related matters.
• Advises Sales Department leaders on compliance-related matters.
• Participates in meetings, trainings, webinars, and other forums in which existing and new regulatory guidelines are being shared/discussed and assisting with communicating and implementing new regulations within the Growth Division
• Analyzes data to identify areas that impact quality within the Growth Division
• Maintains accurate and up-to-date records of all Growth Division training, CAPs, PIPs, and other corrective action documents
• Synthesizes data and produces summary findings reports and presentations for use by the CGO and other members of the Executive Leadership Team regarding Growth Division compliance and regulatory matters
• Works collaboratively with Compliance, Regulatory Affairs, Training & Development, Sales, Human Resources, and Labor Relations to ensure proper lines of communication are maintained
• Other duties as assigned or requested.
• Conducts Field Observations.
• Analyzes production and performance data to identify trends needing corrective action, coaching, training, and monitoring
• Creates and updates training curriculum, drafts testing exams, and creates modules used for process improvement for all Sales personnel to ensure compliance and regulatory standards are achieved and maintained.

Minimum Qualifications

• Bachelor’s Degree from an accredited school required
• At least 4 years of Managed Care experience including thorough knowledge of Medicare, federal, and/or state regulations
• Prior experience required in quality improvement and compliance oversight
• High-level of skill in leading interdepartmental and cross-functional strategy development; experience managing professional staff on multiple projects simultaneously to ensure corporate deadlines and objectives are met.
• Prior experience in a training capacity is preferred but not required

Professional Competencies

• Excellent oral, written, and presentation skills, as well as conceptual and analytic skills are necessary in order to review and articulate corporate objectives and Federal regulations across all relevant audiences
• The utmost integrity in the discreet and confidential handling of confidential materials is necessary
• Good analytical skills are required
• Critical thinking and process improvement skills are a must
• Strong interpersonal skills
• Negotiation skills

#LI-HYBRID

Read Full Description