Associate Director Provider Compliance
Associate Director Provider Compliance
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$ 73096 - 142538
1 Vacancy
Job Description
Description of Work
**Position is Exempt from the State Human Resources Act G.S. 126**
**Position is eligible for a hybrid remote teleworking schedule to include weekly onsite work hours.**Recruitment range for this position is $100641 $110000
The NC Medicaid Office of Compliance and Program Integrity (OCPI) monitors the Medicaid community (beneficiaries providers vendors and internal staff) for compliance with state and federal regulations and potential fraud abuse and neglect. OCPI verifies dollars are paid appropriately for covered services by using claim reviews and investigations implementing recoveries pursuing recoupments and aggressively identifying other opportunities for cost avoidance.
The Associate Director Provider Compliance is a senior management position responsible for assisting the Deputy Director/Chief Compliance Officer in key activities of DHBs Office of Compliance and Program Integrity unit. This position will be responsible for establishing and executing effective oversight protocols of the Special Investigations Units of the States contracted health plans while developing and implementing procedures for conducting provider audits and investigations in accordance with all federal and state rules and regulations to reduce provider fraud waste and abuse. This position will ensure NC Medicaid managed care organizations have and follow sound principles and practices for conducting provider audits investigations and monitoring. This role will work in partnership with DHB Provider Operations and DHB Clinical Policy to facilitate the adequate implementation of provider policies and practices which lead to compliance with Centers for Medicare & Medicaid Services (CMS) rules and guidelines and North Carolina legislative requirements for Medicaid providers.
Job Specific Responsibilities:- Lead the development maintenance and of documented policies and procedures for the establishment of OCPIs provider audits and investigations protocol to prevent illegal unethical or improper payment of Medicaid dollars.
- Lead the development maintenance and of documented policies and procedures for NC Medicaids approach to effective oversight and monitoring of the States contracted Managed Care Plans Special Investigations Units.
- Oversee the scope of work development and of vendors conducting provider audits and investigations under OCPI responsibility and liaise with other business unit leaders for joint provider audit and investigations efforts.
- Enforce provider policies and procedures to include the use of standardized investigations and corrective actions to address identified and reported violations.
- Ensure that the processes and procedures are aligned with authorized enforcement authorities.
- Develop and perform and/or authorize periodic provider audit initiatives to ensure that compliance with clinical and payment policies is being achieved and that the compliance program is relevant and up to date with the needs and requirements of DHB and CMS.
- Successfully liaise and collaborate with OCPI Compliance Analytics Medicaid Investigations Division (MID) legal counsel (e.g. DHB Attorney etc. and others as necessary for expert consultation clarification and/or approval of provider compliancebased initiatives and interests to include escalation of highpriority concerns or violations and prosecutions.
- Measure and report on operational performance and lead the development of plans to improve relevant key performance indicators within the Provider Compliance unit.
- Engage in personnel administration to include but not limited to recruiting selecting and managing employees; delegating to staff members; encouraging and fostering professional development; establishing effective professional goals and work plan objectives.
About the NC Division of Health Benefits:
The Division of Health Benefits (DHB) within NCDHHS is committed to advancing innovative solutions that improve health promote wellbeing and foster independence for all North Carolinians. DHB manages and oversees North Carolina Medicaid and other programs that provide access to services and supports for parents children seniors people with intellectual / developmental disabilities and behavioral health substance use and traumatic brain injury disorders. With a budget over $27 billion in state and federal funds per fiscal year DHB ensures that more than 108000 enrolled providers are reimbursed for delivering covered services to 3.1 million beneficiaries.
About the NC Department of Health and Human Services (DHHS):
The North Carolina Department of Health and Human Services (DHHS) is one of the largest most complex agencies in the state and has approximately 17000 employees. It is responsible for ensuring the health safety and wellbeing of all North Carolinians providing human service needs for special populations including individuals who are deaf blind developmentally disabled and mentally ill and helping poor North Carolinians achieve economic independence.
Compensation and Benefits:
The State of North Carolina offers excellent comprehensive benefits. Employees can participate in health insurance options standard and supplemental retirement plans and the NCFlex program (numerous highquality lowcost benefits on a pretax basis). Employees also receive paid vacation sick and community service leave. In addition paid parental leave is available to eligible employees. Visit website for benefits.Knowledge Skills and Abilities / Competencies
Listed below are the knowledge skills and abilities (KSAs) associated with the position. These KSAs along with the minimum education and experience listed are required in order to be deemed eligible for the position therefore you must provide supporting information within the body of your application to demonstrate your possession of each KSA listed.
Qualified applicants must possess and application must clearly reflect work experience that demonstrates the following:- Documented ability to effectively prioritize and organize work set clear objectives and break largescale projects down to milestone deliverables or outcomes.
- Proficiency in contract/policy analysis interpretation and monitoring for adherence.
- Experience communicating effectively with internal and external stakeholders both verbally and in written form.
- Effective staff performance management skills.
- Effective time management skills.
- Experience managing supervisors or team leads.
- Strong proficiency in Microsoft Office suite including Teams Outlook Excel and Word.
- Previous work experience with a Medicaid agency.
- Experience effectively managing personnel in the of provider audits and investigations.
- Considerable knowledge of healthcare operations.
- Familiarity with state of NC contracting processes including vendor monitoring.
Minimum Education and Experience Requirements
Some state job postings say you can qualify by an equivalent combination of education and experience. If that language appears below then you may qualify through EITHER years of education OR years of directly related experience OR a combination of both. SeeEducation and Experience Equivalency Guide for details.
Masters degree in an area specific to the program from an appropriately accredited institution and five years of experience in the area of assignment including three years in a supervisory or consultative capacity;
OR
Bachelors degree in an area specific to the program from an appropriately accredited institution and seven years of experience in the area of assignment including three years in a supervisory or consultative capacity;
OR
an equivalent combination of education and experience.Supplemental and Contact Information
The North Carolina Department of Health and Human Services (DHHS) is an Equal Opportunity Employer who embraces an Employment First philosophy which consists of complying with all federal laws state laws and Executive Orders. We are committed to reviewing requests for reasonable accommodation at any time during the hiring process or while on the job. For more information about DHHS: uses the MeritBased Recruitment and Selection Plan to fill positions subject to the State Human Resources Act with the most qualified individuals. Hiring salary will be based on relevant qualifications internal equity and budgetary considerations pertinent to the advertised position.
It is critical to our screening and salary determination process that applications contain comprehensive information. Information should be provided in the appropriate areas to include the beginning and ending dates of jobs worked education with the date graduated all work experience and certificates / licenses. Resumes will not be accepted in lieu of completing this application. Answers to Supplemental Questions must refer to education or work experience listed on this application to receive credit. Degrees must be received from appropriately accredited institutions.- Applicants seeking Veterans Preference must attach aDD214 Member4 Form(Certificate of Release or Discharge from Active Duty) to their applications.
- Applicants seeking National Guard Preference must attach a NGB 23A (RPAS) if they are a current member of the NC National Guard in good standing. If a former member of the NC National Guard who served for at least 6 years and was discharged under honorable conditions they must attach either a DD256 or NGB 22.
- If applicants earned college credit hours but did not complete a degree program they must attach an unofficial transcript to each application to receive credit for this education.
- Applicants may be subject to a criminal background check. All candidates selected for positions considered Positions of Trust will be subject to a criminal background check.
Applications for positions requiring specific coursework must be accompanied by a copy of the applicants transcript. Applicants with degrees not conferred at a United States college or university must attach verification that their degree is equivalent to a similar degree from a U.S. institution. The Office of State Human Resources uses the National Association of Credential Evaluation Services (NACES) as a referral resource for applicants who need to have their credentials certified as equivalent. For a list of organizations that perform this specialized service please visit the NACES membership website at Transcripts degree evaluations and cover letters may be uploaded with your application.
NOTE: Applicants will receive communication via email only for updates on the status of their application or any questions on their application. If there are any questions about this posting other than your application status please contact Talent Acquisition at .
To check the status of an application please log in to your NC Government Job Opportunities account and click Application Status.
For technical issues with your application please call theNeoGov Help Line at. If you have a technical issue with your Government Jobs account please call their Help Line at.
Required Experience:
Director
Employment Type
Full-Time
