Providence St. Joseph Health

Job Information

Providence Medicare Advantage Delegation Program Consultant in Beaverton, Oregon

Description:

Providence St. Joseph Health is calling a Medicare Advantage Delegation Program Consultant to our location in Beaverton, OR.

We are seeking a Medicare Advantage Delegation Program Consultant who will be a strategic growth strategy for PH&S and Providence Health Assurance. This position will have regional responsibilities related to Oregon and Washington and other emerging markets. It will be managing and leading various enterprise-wide Medicare compliance-related initiatives and projects in relation to our delegated entities. The project work is multi-faceted requiring complex regulatory analysis and interpretation, the leading of multi-departmental work teams, external contracted entities, preparation and response to CMS audits, coordination of CMS filing required materials and managing multiple and ever changing CMS deadlines. The position serves as an internal consultant and subject matter expert to leadership and staff regarding compliance delegation oversight, regulatory obligations as well as Medicare-specific contracts, benefits, and policies as they relate to those delegated entities. The work of this position impacts PHA's legal and regulatory and financial obligations to CMS as well as our obligations to our Medicare members. Non-compliance can result in legal action, financial sanctions and/or financial recoveries.

In this position you will have the following responsibilities:

  • Manage the PHA Delegation Oversight Program in its entirety.

  • Analyze, interpret and communicate regulatory interpretations to delegates, leadership and staff at PHA.

  • Audit and monitor delegated entities for full compliance with CMS regulations.

  • Perform annual attestation and assessment process for delegated entities.

  • Consult with internal and external resources including legal counsel as needed to fulfill these duties.

  • Provide orientation, training, and support to leadership and staff at PHA regarding regulatory compliance and contract requirements for Medicare products as it relates to delegated entities.

  • Provide support and serves as the primary resource for delegated entities.

Qualifications:

Required qualifications for this position include:

  • Bachelor's Degree or Associate's Degree and 4 years in a related field.

  • 5 years relevant health plan, compliance and/or legal experience or experience in another regulated industry.

  • 5 years experience with two of the following: Process improvement, policy and procedure development, technical or legal writing, written customer communications.

About Providence in Oregon

As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.

The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple,

"Providence will provide the best care and service to every person, every time."

Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.

For information on our comprehensive range of benefits, visit:

http://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Compliance

Location: Oregon-Beaverton

Req ID: 273873

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