This position oversees Medicaid/Medicare, Foundational Community Support (FCS) billing and compliance at VOA. This position is responsible for maintaining routine auditing functions and providing feedback on departmental activities to assure compliance with all health plan and regulatory agencies, including CMS.

Position Type and Expected Hours of Work:

This is a regular full-time position. Typical work hours and days are Monday through Friday, 8:00 a.m. to 5:00 p.m. Some flexibility in schedule is allowed, but must be approved in advance by the supervisor. The schedule may vary and occasionally require longer work hours and varied shifts, as well as evening, weekend, and holiday work.

Essential Duties and Responsibilities:

To perform this job successfully, an individual must be able to satisfactorily perform each of the essential duties/responsibilities listed below. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties/responsibilities of this job. The essential functions of the position include, but are not limited to the following:.

• Provide on-going oversight and monitoring of Medicaid business operations to ensure full compliance and minimize risk for the company.
• Enforces compliance policies by inspecting facilities to detect existing or potential areas of noncompliance.
• Conducts compliance risk assessments and corresponding audits and monitoring.
• Utilize risk assessment data to identify error trends and root causes, and make recommendations for performance improvements.
• Maintain working knowledge of laws and regulations, contract documentations, amendments, and various compliance measures pertaining to Medicaid and managed care.
• Conduct monitoring and/or periodic auditing activities in such a way that ensures all regulatory and standards are understood, business processes required to address those regulations and standards are implemented, and any compliance risks are communicated to leadership.
• Draft compliance communications for the organization as necessary
• Serve as subject matter expert for requirements for all Medicaid contracts and participation agreements.
• Establish relationships and maintain open lines of communication with internal departments and external vendors to ensure an organization-wide culture of compliance and operational processes to prevent and detect noncompliant activities.
• Interpret and define Medicaid regulatory and contract requirements to be implemented by appropriate departments.
• Work collaboratively with programs to implement controls that enhance the efficiency and effectiveness of the Medicaid billing process.
• Communicate with and present to state Medicaid departments and manage Medicaid health plans. Build positive relationships with these external partners.
• Develop, implement, and maintain organizational procedures and trainings that are in compliance with local, state, and federal regulations.
• Works cross-functionally to assure that Medicaid requirements are met including:
  • Data reporting
  • Special client assessments
  • Medical records content and timeliness requirements specific to Medicaid
  • Staff education required by Medicaid
  • Corporate integrity and fraud, waste, and abuse requirements
  • Billing and coding requirements
• Supervise ongoing audits to assure compliance
• Completes corrective action plans specific to Medicaid audits.
• Proactively monitor new requirements for all current and future Medicaid contracts.
• As department grows: Hire, train and supervise Medicaid compliance specialists
• In Partnership with the Director of Special Projects and the SVP of Operations, develop and implement an effective and comprehensive compliance program.

Additional Duties and Responsibilities:

• Performs other related duties as required or assigned.
• Occasional travel during work hours to complete program visits.
• This role may have supervisory responsibilities.

Benefits:

Monetary compensation for this role is $31.48 per hour, but other benefits of working at VOA go far beyond that:

• 8 Paid Annual Holidays
• Up to 5 additional discretionary annual holidays (depending on hire date)
• Paid Sick Leave
• Paid Time Off
• Mileage Reimbursement
• FREE Dental and Vision Insurance
• Life insurance, Medical and Disability
• Three Aflac Insurance Policies to electively enroll in: Accident Protection, Critical Illness and Hospital Indemnity
• 403(b) Retirement Plan including up to 25% employer match up to $500 per year
• Company-issued cell phone and laptop
• FREE CPR/First Aid Training
• FREE Bloodborne Pathogens Certification
• FREE WA State Food Handler’s Permit
• Ongoing program specific training and professional development training
• Opportunity for career growth and professional development
• Work/Life Balance: We are dedicated to being flexible for family and self-care!

• Bachelor’s degree in business administration, public administration, law, public health, health administration or a related field OR
• an equivalent combination of education and experience.
• Previous experience in Medicaid and compliance

Certificates and/or Licenses: To perform this job successfully, an individual must:

• have a valid Driver’s License
• have the ability to be bonded and/or insured (Auto Liability Insurance)
• successfully pass background checks applicable to position:
  • Washington State Patrol Criminal History Search; and
  • Driving Record Review

Preferred Education and/or Experience:

• Previous experience with Foundational Community Supports, Excel and EHR Systems (Credible)
• Previous experience in the non-profit sector

Skills, Abilities, and Competencies: For an employee to succeed in this position they must have:

• Ability to communicate effectively, orally and in writing; including demonstrated strong interpersonal skills.
• Ability to retain high professional standards regarding confidentiality.
• Ability to multi-task and work in a high volume, fast-paced environment, balancing changing priorities.
• Proven ability for attention to detail.
• Ability to interact effectively with employees and managers from diverse socio-economic and ethnic backgrounds.
• Excellent public speaking skills for large and small groups.
• Strong analytical and organizational skills.
• Knowledge of Medicaid enrollment services and process.
• Proficient in word processing applications and associated software such as Excel, Google Suite, Microsoft Suite and Adobe.
• Proficient reporting skills including auditing data and processes regularly to produce reports and/or communications to applicable stakeholders.

Physical Requirements:

In order to meet all expectations of this position, an individual must be able to:

• This job operates in a professional office environment. The noise level in the work environment can be loud at times. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines.
• While performing the duties of this job, the employee may be occasionally exposed to pests, pathogens, and service or emotional support animals.

Work Conditions:

While performing the essential duties/responsibilities of this job, the employee may experience the following environmental conditions at the frequency indicated:

• While performing the duties of this job, the employee is regularly required to effectively communicate with VOA staff, funders, and/or community partners and must be able to efficiently exchange accurate information in these situations.
• The employee frequently is required to remain in a stationary position (such as sitting or standing) and to move about inside and outside of the office and shelter to access file cabinets, office machinery, etc. The employee may occasionally be required to ascend and descend stairs within the Administrative offices on the second floor of the building. The employee must frequently lift and/or move files and/or cleaning supplies (up to 10 pounds) and occasionally help to lift and/or move boxes of files. (up to 25 pounds).
• This role constantly operates a computer with keyboard and mouse, as well as other office equipment. The employee must be able to perceive text and buttons on the computer screen and discern print and handwriting on paper forms in order to find and verify invoices, complete intake forms, and perform other tasks involving physical and electronic documentation.