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ADMINISTRATIVE PROGRAM MANAGER I

Compliance Manager

Recruitment #16-005472-0004

GRADE

19

LOCATION OF POSITION

MHBE

750 E. Pratt Street, Baltimore, MD  21202

Main Purpose of Job

The main purpose of this position is to ensure the effectiveness of Compliance and Ethics programs at MHBE. This position supports the Chief Compliance Officer through monitoring and the performance of internal and external financial and programmatic audits to ensure the Exchange, Exchange Contractors and other entities meet Affordable Care Act as well as applicable State and Federal laws, regulations and contractual obligations.

POSITION DUTIES

Develop, implement and maintain an effective audit program that will conform to acceptable industry standards, i.e. Generally Accepted Government Auditing Standards (GAGAS), Computer Matching Agreement, MARS-E.  

Implement an audit system to protect MHBE resources through a review of standards, detection of non-compliance and/or fraud, waste and abuse, and facilitation of corrective action plans that promote compliance with State and Federal Law.  

Use MHBE audit standards to perform external monitoring activities of contractors, including but not limited to, qualified health plans, connector entities, certified assistants sponsoring entities, producers, and vendors to promote their compliance with  applicable 45 CFR 155 and 156 standards;  

Perform and/or assist in the performance of internal audits, monitoring activities and/or investigations pertaining to contracts, procurements or any other substantive complaints of fraud, waste and abuse of MHBE resources. Audit compliance with federal and other billing requirements when the MHBE is the provider of services.  

Collaborate with contract monitors to ensure they obtain and/or create appropriate documentation and/or metrics to support vendor compliance with contract and billing requirements.  In the event of non-compliance with contract is found, support contract monitor in the review of corrective action plans to ensure outcome metrics effectively measure improvements.            

Coordinate outside agencies’ audit requirements with MHBE personnel as required by various federal agencies as well as independent audits being performed annually. 

Represent the Compliance department in meetings, hearings, conferences, or any other activity as requested.

MINIMUM QUALIFICATIONS

Education: A Bachelor's degree from an accredited college or university.

Experience: Four years of experience in administrative staff or professional work.

Notes:

1. Additional experience in administrative staff or professional work may be substituted on a year-for-year basis for the required education.

2. Additional graduate level education at an accredited college or university may be substituted at the rate of 30 semester credit hours on a year to year basis for the required general experience.

3. Candidates may substitute U.S. Armed Forces military service experience as a commissioned or non-commissioned officer involving staff work related to the administration of rules, regulations, policy, procedures and processes, or overseeing or coordinating unit operations or functioning as a staff assistant to a higher ranking commissioned officer on a year to year basis for the required education and experience. 

DESIRED OR PREFERRED QUALIFICATIONS

Desired or Preferred Qualifications:

1. Certified in Health Care Compliance.

2. Juris Doctorate

3. Contract Audit experience using GAGAS. 

EXAMINATION PROCESS

The assessment may consist of a rating of your education, training and experience related to the requirements of the position. The rating may also be based on your application. Therefore, it is important that you provide complete and accurate information on your application. Report all education and experience related to this position. Qualified candidates will be rated as either Best Qualified, Better Qualified, or Qualified and placed on the eligible list for a period of at least one year.

BENEFITS

FURTHER INSTRUCTIONS

Please make sure that you provide sufficient information on your application to show that you meet the qualifications of this recruitment.  All information concerning your qualifications must be submitted by the closing date.  We will not consider information submitted after this date.

The online application process is strongly advised, if the online process is not available to you, you may complete and submit a completed paper application along with the supplemental questions to:

Shadrick.phillips1@maryland.gov

           or

Shadrick Phillips

Maryland Health Benefit Exchange

750 East Pratt St., 16th Floor

Baltimore, Maryland 21202

TTY  Users: call via Maryland Relay 1-800-735-2258

As an equal opportunity employer Maryland is committed to recruiting, retaining and promoting employees who are reflective of the State’s diversity.

We thank our Veterans for their service to our country, and encourage them to apply.




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