AbleTo

  • Compliance Manager

    Job Locations US-NY-New York
    Posted Date 3 weeks ago(09/26/2018 5:39 PM)
    ID
    2018-1912
    # of Openings
    1
    Category
    Compliance
  • Overview

    AbleTo, Inc. is a market leader in providing technology-enabled behavioral health care. AbleTo has been treating patients for over six years, and improves patient outcomes and lowers costs by providing treatment that integrates behavioral and medical health care. AbleTo's structured therapy programs strengthen medical recovery and self-care among members with chronic or complex clinical needs. AbleTo analytics, coupled with our multi-channel engagement platform, identify and engage members with unmet, often undiagnosed, behavioral health needs. A proprietary platform connects individuals and their care teams with AbleTo licensed providers who deliver weekly sessions by phone or video supported by an integrated digital experience.AbleTo programs are clinically proven to improve both behavioral health and medical outcomes while lowering overall spending for higher-cost, higher-risk members.

     

    The Compliance  Manager will report to the Corporate Compliance Officer and assist with developing, managing, implementing, auditing and monitoring activities. Will provide training to AbleTo staff to assure compliance, as described in the annual compliance work plan. Strong analytical and communication skills required to ensure service lines and business areas have processes and guidelines in place to comply with applicable State and Federal laws and regulations for Medicare and Medicaid, and other third party insurers. Business areas will include, but are not limited to: eligibility, engagement and service centers, marketing, billing, clinical, and provider network. Independent monitoring in analyzing risk assessments, overseeing third parties in assessments, performing audits, creating reports and scorecards, educating and following up with agencies to ensure processes exist that demonstrate compliance with applicable laws, regulations, accreditations, and client contractual commitments.

    Responsibilities

    • Manage daily operation of the compliance audit and monitoring program (including audit, review, data analysis and staff training initiatives) and regularly reports to the Compliance VP on the status of the program
    • Coordinate internal and external audits, compliance scorecards, reviews and investigations of business lines
    • Project manage state/federal, client, and third party audits
    • Analyzes audit findings, reports and assessments and provides recommendations for corrective action plans
    • Assists the VP Compliance to develop scorecards, and maintains data to track and display key audit areas for each service line
    • Assist the VP Compliance in managing, monitoring, and educating the organization to ensure compliance with internal policies
    • Assist with issue identification, maintenance of compliance logs (call center, provider, patient, client, internal concerns, etc.).  Input information into compliance log tracking tool. Develop reports for relaying information to Board of Directors and clients, when needed
    • Work collaboratively with each business unit to make appropriate recommendations to procedures and guidelines to ensure compliance with stated regulations
    • Assist in advising on new product/service development
    • Assist with documenting, tracking, and investigating privacy/compliance cases; assist with collaborating with Account Management to report up to clients as needed; assist with reporting to government bodies
    • Provide education and training for staff to ensure quality, accuracy and timeliness of documentation
    • Maintain a working knowledge of rules and regulations, including HIPAA/HITECH, CMS application to business
    • Assist the Compliance VP in reviews and investigations of compliance issues or concerns within the organization to appropriately evaluate and resolve in a timely manner
    • Assist internal committees on quality improvement and third party governance
    • Oversee consultants assisting on compliance matters and oversee implementation of compliance controls within the business
    • Attend meetings on behalf of Compliance VP as needed
    • Collaborate with outside counsel when necessary

    Qualifications

    Position Requirements:

    • Bachelors required/ Masters or JD preferred
    • Two + years Quality/Compliance clinical documentation and/or internal audit experience
    • Knowledge of tools and techniques used to conduct audits, research, analysis and evaluations
    • Working knowledge of state and federal regulations, CMS, health plan, healthcare provider and health system requirements
    • Interest in innovation and healthcare delivery
    • Must have ability to analyze data and make data-driven strategic decisions
    • Excellent organizational and training skills
    • Excellent verbal and written communication skills
    • Excellent ability to maintain confidentiality and integrity
    • Must possess excellent interpersonal relationship skills
    • May be required to travel outside of State to business locations as needed, i.e assist VP Compliance with Board presentations
    • Google Suite proficiency

     

    Preferred Qualifications:

    • Experience leading compliance and privacy audit functions

     

    Competencies:

    • Ability to think strategically, plan, execute, measure results and drive continuous improvement
    • Strong technical background with excellent written and verbal communication skills
    • Good listening skills and quick thinker
    • Project management abilities
    • Professional attitude and demeanor with great team collaboration skills
    • Discipline and organization to handle multiple priorities simultaneously
    • Demonstrate personal ownership of and follow through on assignments

     

     

    AbleTo is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status. AbleTo is an E-Verify company.

     

    Upon the acceptance of an offer to enter into this agreement, AbleTo requires the satisfactory completion of reference and background checks and successful completion of drug testing in accordance with local, state and federal laws.