Established in 1983, Dean Health Plan is the insurance services subsidiary of Dean and SSM Health. It maintains a position of leadership in insurance services through a physician-led integrated health system that improves the health of its members and delivers a superior level of service and care. We're looking for talented individuals committed to improving the health of community through innovation, partnership and integrity.
The Government Programs Oversight Specialistis responsible for managing all aspects of Dean Health Plan’s oversight of the Medicare and/or Medicaid products’ operations and ensuring all oversight tasks are properly completed on schedule. All functional areas that provide support for Dean Health Plan’s Medicare and/or Medicaid products, including those of any involved First Tier, Downstream, Related Entity (FDR), must be overseen. This requires on-demand, monthly, quarterly, and annual control, coordination, and communication management, and is the primary role of the Government Programs Oversight Specialist.
Essential Job Duties:
1. Independently act as the day-to-day Dean Health Plan product oversight liaison internally and with all FDRs; manage all oversight questions, risks, issues, improvement requests, on-site visit requests, meetings, etc.
2. Participate in Dean Health Plan’s Auditing & Monitoring Committee meetings; participate in creation of meeting agendas, develop “oversight findings” documents for meetings, ensure meeting minutes are properly taken and stored, coordinate FDR participation in any meetings, review/address oversight issues and risks with the committee, and manage all other aspects of running a successful meeting as defined by the Medicare Compliance Officer (Auditing & Monitoring Committee chair).
3. Ensure that each oversight finding is regularly monitored by the Auditing & Monitoring Committee until it is determined the gap that caused the finding has been satisfactorily closed.
4. Assist in developing ad hoc and scheduled oversight summary documents for Dean Health Plan’s Compliance Committee, including executive-level oversight updates, significant oversight issues and risks, significant oversight FDR recommendations, oversight staff/resource requests, etc.
5. Manage the incoming flow of oversight reports, data/universes, case files, etc. internally and from all FDRs, and distribute them to the appropriate Dean Health Plan staff responsible for oversight evaluation.
6. Manage the oversight evaluation tasks; the tasks include reviewing/evaluating the FDRs’ operational reports, data/universes, case files, etc., confirming the outputs/results/approaches satisfy the expectations detailed in the FDRs’ P&Ps as well as satisfy industry best practices.
7. Perform all necessary oversight communications to Dean Health Plan management, the Audit & Monitoring Committee chair and members, and oversight staff.
8. Communicate Dean Health Plan-recommended operational or oversight changes to all FDRs, ensure P&Ps are modified, and monitor for improvements that should be experienced as a result of the implemented changes.
9. Manage changes to the oversight processes due to Medicare and/or Medicaid product changes, including business unit oversight process changes, oversight communication improvements, Audit & Monitoring Committee changes, etc.
10. Manage the annual review of Dean Health Plan’s and the FDRs’ Medicare and/or Medicaid operational and oversight P&Ps; identify and communicate all changes as needed.
11. Coordinate obtaining answers and feedback for submission of the annual CMS “Readiness Checklist for Medicare Advantage and Prescription Drug Plans, 1876 Cost Plans, and PACE Organizations”, and provide the information to the Medicare Compliance Officer to complete the attestation process in HPMS.
12. Ensure all Dean Health Plan’s oversight documents are centrally located and stored, to support future CMS, OCI, and/or DHS audits, as defined by Dean Health Plan Compliance; includes by-product agendas, meeting minutes, P&Ps, findings documents, recommendation documents, etc.
13. Provide support to Internal Audit during any future CMS, OCI, or DHS Medicare and/or Medicaid audit.
14. Complete other duties as assigned.
1. Bachelor’s degree in business or a related field.
2. 3-5 years of applicable experience.
3. Strong analytical, logical, organizational, communication, problem solving, and interpersonal skills.
4. Effectively work on an independent basis.
5. Excellent verbal and written communication skills and negotiation skills.
6. Effectively initiate process improvements.
7. Ability to successfully manage multiple projects.
8. Ability to work within deadlines in fast-paced environment.
9. Strong PC skills in a Windows environment with Microsoft suite including SharePoint.
10. Ability to read and gain an understanding of new regulatory requirements and support implementation of those requirements as needed.
11. Experience in statistics, analysis, project management, and data reporting.
12. Ability to review and interpret oversight information to identify potential or actual compliance risks, and/or to confirm that compliance expectations are met.
13. Ability to write intelligible reports and develop diagrams suitable for circulation to directors and executives.
14. Strong leadership skills; the ability to effectively manage people at all levels and manage multiple projects.
15. The ability and experience to understand and recognize business objectives and associated risks/issues.
16. Working knowledge of the business unit functions that support the organization’s Medicare and/or Medicaid products.
1. In-house managed care, Medicare, Medicaid or other Government Program compliance or internal audit experience.
Internal Number: REQ #: 18014584
About Dean Health Plan a Subsidiary of SSM Health
About Dean Health Plan
With access to more than 4,000 practitioners at nearly 200 primary care sites and 28 hospitals, Dean Health Plan is one of the largest and most diversified HMOs in the Midwest. It maintains a position of leadership in insurance services through a physician-led integrated health system that improves the health status of its members and delivers a superior level of service and care. Products include HMO and freedom-of-choice insurance plans for commercial and individual customers, Medicare and Medicaid programs, and third party administrator services.