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Supervisor, Regulatory Compliance & Accreditation

Company: AvMed
Location: Miami
Posted on: September 24, 2022

Job Description:

Embrace better opportunities.

Are you passionate about health, happiness and helping others? So are we. We're committed to helping our health plan Members live a happy and healthy lifestyle, and we believe that it starts here first, with our Associates.

At AvMed, we provide the tools and opportunities to enhance, expand, and support each Associate's personal and professional growth. From tuition reimbursement to exercise classes in the office, embrace a better career with AvMed and join our team!

Position: Supervisor, Regulatory Compliance & Accreditation

Scope of position: The Regulatory Compliance & Accreditation Supervisor position is responsible for managing the CMS regulatory requirements and the NCQA accreditation preparedness and representing the department for all audits as needed. This position is responsible for providing supervision, leadership, coordination, and management of all Quality Assurance projects/requirements by developing, maintaining, and enhancing AvMed processes in order to meet the CMS and NCQA accreditation requirements while maintaining AvMed in a state of continuous accreditation readiness.

In addition, the Regulatory Compliance & Accreditation Supervisor is to provide supervision, oversight, and auditing of the day-to-day activities in the Quality Assurance/Member Relations department to assure all areas stay in compliance with all regulatory agencies. Responsible for ensuring that the assigned unit adheres to department performance standards and operational efficiency. Continuously improves the effectiveness and efficiency of operations in the assigned unit, utilized working knowledge of all Quality Assurance areas to ensure that department is fully compliant with all government regulations. Monitors staff to ensure adherence to all department and company policies. Works with other departments to maximize cooperative relationships, acts as an interface with others for excellent customer service and process improvement.

Essential Job Functions:

  • Perform highly complex level of technical and analytical work under minimal supervision in support of the successful compliance with CMS and NCQA Accreditation. Develop plans and keep objectives by completing projects within budget and mandated timeframes. Prepare required materials and reports for reviews of NCQA, CMS, and other regulatory and accreditation agencies.

    • Manages the day-to-day operations of the staff including new hires. Ensures the appropriate staff responds to all member/provider inquiries within stipulated time frames, thereby ensuring member/provider satisfaction and compliance. Have accountability for all performance issues and take appropriate action as warranted. Responsible for identification of root cause analysis of grievance and appeal issues working with applicable business areas to resolve issues. Reviews daily/weekly/monthly reports to ensure proper research is being performed and timeframes met. Works with staff as needed to improve performance, monitor attendance and punctuality, completes performance reviews and conducts staff meetings to encourage open communication and build team morale.

      • Present information and regular reports to management and QI committees on the accreditation maintenance plan and status of accreditation compliance and preparedness

        • Handle all CTM and HISC inquiries received through the appropriate portals. Monitor the portals daily for new inquiries.

          • Monitor/audit AvMed and delegated vendor processes, procedures, and practices to ensure ongoing compliance with all accreditation standards.

            • Oversee the ongoing completion of accreditation document submission and preparation of documentation for scheduled surveys and other regulatory audit activity.

              • Assist the Manager with the preparation of the Member Engagement Annual Evaluation and Workflows of the department

                • Monitor CMS and NCQA websites and other publications for updates to standards and oversee the implementation of changes to continued compliance to the most current standards.

                  • Serve as Subject Matter Expert for all of the Medicare regulations requirements and the accreditation process for all the NCQA Standards that Member Engagement owns and a role model for other team members, both within and outside of the department.

                    • Performs additional duties and responsibilities as assigned by management.

                      We Offer:

                      • Competitive Salaries
                      • Comprehensive Benefits: Medical Plans, Health Savings Account, Dental, Vision, and more---
                      • Paid Time Off, Company Paid Holidays, Paid Time Off Cash-In
                      • 401(k)plan with matching contributions, Tuition Assistance, Associate Discounts

                        You have:

                        • Associates required
                        • Bachelor's preferred
                        • 3-5 years of experience in Managed Care Experience with Medicare/Medicaid and Commercial products
                        • Accreditation and or regulatory experience

                          You May Also Have:

                          • Working knowledge of the Microsoft Office Product Suite (Access, Excel, Word, PowerPoint, and Project) Visio flowchart/diagram software and Internet
                          • Knowledge of other current AvMed systems helpful
                          • Knowledge of coding practices and medical terminology required
                          • Effective interpersonal skills and ability to communicate effectively, orally and in writing, with all levels within the Company, provider community, regulatory agencies, contracting agents and members
                          • Continuous Quality Improvement experience required
                          • Able to work independently as a team leader and as a team member
                          • Understanding of vendor contracts and requests for proposals/demonstrations helpful.
                          • Initiative and self-direction
                          • Strong detail oriented and organizational skills
                          • Effective decision-making
                          • Ability to identify and understand the data needs of department
                          • Analyze, interpret, and manipulate raw data in order to provide clear and concise information
                          • Problem identification, analysis, and resolution
                          • Ability to function effectively under stress and deadlines


                            At AvMed, you will find a family. Our Associates love all the opportunities for advancement, the flexible work environment and team activities. We also encourage our Associates to embrace a life rich in what matters most - health and happiness. We call it beingWELLfluent. Join AvMed. Join theWELLfluent!

                            Location:Doral, Florida

                            This position is Hybrid 2 days in office and 3 days remote

                            AvMed is a tobacco/drug free workplace, EOE

Keywords: AvMed, Miami , Supervisor, Regulatory Compliance & Accreditation, Other , Miami, Florida

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