Compliance, Privacy, and Contract Manager

Medical Associates Health Plans is hiring a Compliance, Privacy, and Contract Manager to join our team! This role will report to our Chief Operating Officer to help provide organization-wide support and leadership regarding compliance, privacy, and contracting related programs and processes. Where You Will Be Working:  Medical Associates Clinic and Health Plans is a multi-specialty group practice combined with a growing health insurance company.  Our 1,100 healthcare and health insurance professionals lead the way in providing quality healthcare and top-notch insurance products in Northeast Iowa, Southwest Wisconsin, and Northwest Illinois. This position is an onsite position, based out of the compliance department located at the Medical Associates Health Plans in Dubuque, Iowa. Skills You Bring: 

• Solid interpersonal skills and ability to work collaboratively and lead effectively while influencing positive change.
• Strong organization skills, multitasking, and follow-through 
• Positive, energetic personality with ability to make quick, tough decisions
• Preference will be given to candidates with a legal background

Benefits Package Includes:  

• Single or Family Health Insurance with discounted premium rates for wellness program participation.
• 401k with immediate matching (50% on the dollar up to 7% of pay) + additional annual Profit Sharing
• Flexible Paid Time Off Program (29 days off/year)
• Medical and Dependent Care Flex Spending Accounts
• Life insurance, Long Term Disability Coverage, Short Term Disability Coverage, Dental Insurance, etc. 

Major Responsibilities: MAHP Compliance

• Develop and maintain processes, systems and explicit measures that ensure timely and accurate execution of compliance requirements.
• Lead and oversee all health plan compliance policies and procedures and assist in updating or developing new policies to improve operations, advance internal controls, or to meet new regulations/requirements.   
• Provide compliance review of federal, state, Center for Medicare and Medicaid Services (CMS) and Department of Insurance (DOI) requirements.
• Lead the Compliance team, establish annual objectives, provide ongoing feedback and support, create capacity plan, 
• Serve as a consultant to the health plan for compliance and regulatory questions and concerns.  Identify when an issue or question requires outside support or counsel.
• Coordinate with the Analytics Department on internal monitoring and auditing for policy compliance, discover preventive and corrective measures executed for audit findings and coordinate internal and external corrective measures to be executed. 

Regulatory Compliance and Oversight

• Be informed of current legislation and enforcement issues affecting the healthcare industry, including but not limited to Medicare Cost Plan requirements, Commercial Health Plans, Clinical Quality, Pharmacy and PBMs, Accreditation, compliance best practices, and HIPAA.
• Work closely with departments for effective investigation, resolution, reporting, and remediation of compliance issues.  Prepare report for management on incidents, investigations, and all compliance issues and present at Compliance Committee meetings when appropriate. 
• Responsible for communication and coordination of issues requiring external counsel or external carrier support, guidance, or expertise.  Ensure appropriate external expertise is in place to cover the work being performed. 

Contracting

• Maintain entity provider contract templates for MAHP in compliance with federal, state, CMS and DOI requirements as may be applicable. 
• Perform annual review and then as needed during the negotiation process.
• Develop and maintain contract oversight and checkoff process to assure proper review, signoff and management of entity contracts.
• Consult with health plan team related to contracts and contracting process.

Serve as the Medical Associates Privacy Officer for both the MA Clinic and MA Health Plans. Oversee Medical Associates HIPAA Compliance program, including monitoring changing regulatory environment and performing audits such as electronic medical record tracking and personnel audits as needed.  Annual review of all related documents and processes related to meeting Privacy requirements. Knowledge and Skills: Experience                        Three years to five years of similar or related experience. Education          Juris Doctor (J.D.) degree from an approved law school, with admittance to at least one state bar in good standing is preferred. Interpersonal Skills       A significant level of trust and diplomacy is required, in addition to normal courtesy and tact.  Work involves extensive personal contact with others and/or