Compliance Coordinator (HCPMDAIO)

Compliance Coordinator (HCPM/DAIO)

The Compliance Coordinator (Health Care Program Manager) provides management of the Recovery Audit Contractor (RAC) program along with other utilization review programs. The role is an expert at contract management internal planning coordinating with external partners and monitoring policy compliance operations and reporting. This is a great opportunity to work closely with program managers financial administrators senior compliance counsel and external entities to ensure timely and compliant recovery of public funds.

All HCA employees will apply an equity lens to their work which may include but is not limited to all analyses of core business and processes.

About the division:

The Office of Regulatory Compliance & Oversight (ORCO) is part of the Division of Audit Integrity and Oversight (DAIO) within the Office of the Chief of Staff of HCA. ORCO provides technical assistance resources and oversight functions of federal and state grants subawards and state Medicaid expenditures. ORCO is HCAs centralized body to provide leadership education and support to all divisions of the agency at all employee levels to mitigate risks comply with changing laws and assist the agency in accomplishing its goals directly related to federal grant and Medicaid oversight and compliance.

About the position:

The HCPM position will report directly to the Program Integrity Liaison and will provide centralized management coordination and facilitation of the Recovery Audit Contractor (RAC) program and Surveillance and Utilization Review System (SURS) program and management and oversight of CMSs Unified Program Integrity Contractor (UPIC). As an expert this position will primarily focus on contract management of the RAC as well as agencywide internal planning coordinating monitoring managing and evaluating the internal RAC program structure operations policy/procedure development and reporting.

This position is eligible to telework and is typically not required to report on-site.The default assigned work location of all Health Care Authority (HCA) positions both on-site and telework eligible positions is within the State of Washington. This position reports to Olympia WA. Frequency of onsite work will vary based on business and operational needs. All agency employees are required to report on-site in Olympia on their first and last days of employment to pick up and return state-issued equipment regardless of telework status or location.

Some of what you will do:

• Develop manage implement and provide expert advice to different levels of management at HCA as well as some external agencies on policies and procedures regarding the RAC program.
• Independently ensure internal operational compliance with federal rules and regulations governing the RAC program.
• Lead and develop internal process improvements to enhance utilization of the RAC contractor.
• Manage and oversee the performance and deliverables of HCAs contracted vendor for the RAC program. This includes ensuring contract compliance timely deliverables and adherence to communication standards both internally and externally.
• Review and approve all invoices issued to HCA from the RAC contractor. Review must be thorough and ensure that all amounts invoiced are an established percentage of dollars recouped by the RAC contractor.
• Manage and monitor all overpayment recovery activities resulting from the work of the RAC and the UPIC and internal audit unit.
• Receive track record and reconcile all recovery payments owed and received.
• Accurately record all offsets.
• Configure and submit accurate mass adjustments to other internal DAIO financial team members or to external agencies such as Office of Financial Recovery (OFR) as needed.
• Act as the primary liaison with the FSD regarding overpayment recovery processes and flows.
• Analyze and evaluate mass adjustments to determine if the adjustments were processed according to state and federal policies and regulations and if necessary either directly or coordinate with financial staff to correct discrepancies.
• Responsible for managing DAIOs cash receipt process.
• Monitors tracks logs reconciles and reports all questioned and disallowed costs from state and federal grant funded contracts including RAC program.

Required qualifications:

Qualifying candidates will meet one of the following criteria options:

Option 1:

Masters degree or higher in public health behavioral health public administration business administration social work or closely related field and three (3) years of consultative or supervisory experience in health services social services Medicaid behavioral health or other health care programs.

Option 2:

Bachelors degree in a field identified above and five (5) years of consultative or supervisory experience in health services social services Medicaid behavioral health or other health care programs.

Option 3:

Associate degree in a field identified above and seven (7) years of consultative or supervisory experience in health services social services Medicaid behavioral health or other health care programs.

Option 4:

Nine (9) years of consultative or supervisory experience in health services social services Medicaid behavioral health or other health care programs.

Option 5:

One (1) year as a Health Care Program Specialist (HCPS or formerly a MAPS2) in State Government with duties and responsibilities involving consultative or supervisory experience in health services social services Medicaid behavioral health or other health care programs.

Required competencies:

• The ability to take action to learn and grow.
• The ability to take action to meet the needs of others.

Preferred qualifications:

• Experience as a Medical Assistance Specialist 3 with at least two years of claims processing adjusting and investigation.
• Experience managing contractors/vendors including performance management inspection of deliverables and approving invoices
• Demonstration of the ability to gather information from a variety of resources. Condense content and produce comprehensive informative reports.
• Proficient in the use of Microsoft software including Word Excel and Access.
• Knowledge of current and developing trends in medical healthcare delivery and billing.
• Knowledge of and application of federal and state rules and regulations related to health care program integrity Medicaid and pertinent HCA policy and contract requirements in oversight activities.
• Working knowledge and ability to use Washington State Apple Health (Medicaid) claims payment/processing system such as ProviderOne and Point of Sales

How to apply:

Only candidates who reflect the minimum qualifications on their NEOGOV profile will be considered. Failure to follow the application instructions below may lead to disqualification. To apply for this position you will need to complete your profile which includes three professional references and attach in separate files:

• A cover letter that specifically addresses how you meet the qualifications for this position
• Current resume

To take advantage of veteran preference please do the following:

• Attach a copy of your DD214 (Member 4 long-form copy) NGB 22 or USDVA signed verification of service letter.
• Please black out any PII (personally identifiable information) data such as social security numbers. Include your name as it appears on your application in .

About HCA:

Functioning as both the states largest health care purchaser and its behavioral health authority the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars HCA purchases health care including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention crisis and recovery supports to all Washington residents.

What we have to offer:

• Meaningful work with friendly co-workers who care about those we serveVoices of HCA
• A clear agency mission that drives our work and is person-centeredHCAs Mission Vision & Values
• A healthy work/life balance including alternative/flexible schedules and mobile work options.
• A great total compensation and benefit packageWA State Government Benefits
• A safe pleasant workplace in a convenient location with restaurants and shopping nearby.
• And free parking!

Notes:

Prior to a new hire a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment.

HCA is an equal opportunity employer. We value the importance of creating an environment in which all employees can feel respected included and empowered to bring unique ideas to the agency. HCA has five employee resource groups (ERGs). ERGs are voluntary employee-led groups whose aim is to foster a diverse inclusive workplace aligned with HCAs mission.Our diversity and inclusion efforts include embracing different cultures backgrounds and viewpoints while fostering growth and advancement in the workplace. Studies have shown women racial and ethnic minorities and persons of disability are less likely to apply for jobs unless they feel they meet every qualification as described in a job description. Persons over 40 years of age disabled and Vietnam era veterans as well as people of all sexual orientations and gender identities are also encouraged to apply. If you have any questions about the required qualifications or how your experience relates to them please contact us at .Persons with disabilities needing assistance in the application process or those needing this job announcement in an alternative format may contact Lisa Fleming at or

The Washington State Health Care Authority (HCA) is an E-Verify employer. All applicants with a legal right to work in the United States are encouraged to apply.

E-Verify is a registered trademark of the U.S. Department of Homeland Security.