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ADMINISTRATIVE PROGRAM MANAGER I

Compliance & Audit Manager

Recruitment #24-005472-0004

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Introduction

MHBE is accepting applications for a vacant Compliance & Audit Manager position!

Maryland Health Benefit Exchange is responsible for the administration of Maryland Health Connection, the State's health insurance marketplace, under the Patient Protection and Affordable Care Act of 2010(ACA). MHBE works with the Maryland Department of Health, Maryland Insurance Administration, Department of Human Services, and stakeholders statewide.

Vision Statement: High-quality, affordable health coverage for all Marylanders.
Mission Statement: We improve the health and well-being of Marylanders by connecting them with
high-quality, affordable health coverage through innovation, technology, and customer service.
Values: Diverse & Inclusive, Innovative, Collaborative, & Ethical.

For more information on MHBE, please visit our website.

GRADE

19

LOCATION OF POSITION

MHBE is adhering to a hybrid work schedule. Work for this position will be completed at a remotelocation of your choice (3 days) and at our office located at 750. E. Pratt St, 6th Floor, Baltimore, MD21202 (2 days).

Main Purpose of Job

The main purpose of this position is to promote the effectiveness of the MHBE Compliance and Privacy program by supporting the Director of Compliance and Privacy and performing internal and external audits and monitoring to ensure the Exchange and its contractors follow applicable laws, regulations, policies, and contractual obligations. The goal of MHBE’s Compliance and Privacy program is to instill a sense of public trust by providing services with the highest level of ethical, business and legal standards. In furtherance of promoting public trust, MHBE is dedicated to maintaining an effective program to detect and prevent fraud, waste and abuse. To the extent that MHBE contracts certain services to run the Exchange, those services need to comply with applicable federal and State laws and regulations, to include 45 CFR 155, Affordable Care Act, State-based Exchanges, Senate Bill 374, Computer Matching Agreement, Maryland False Claims Act, Executive Order 01.01.2017.01 Standards of Conduct as well as Ethics Laws set forth in set forth in Md. Code Ann., State Gov't §§ 15-101 through 15-1001. Duties include developing and maintaining audit programs; conducting/performing audits of the policies, procedures and financial transactions of the Maryland Health Benefit Exchange and/or its contractors receiving Medicaid or State funding; assisting in the performance of auditing of qualified health plans; conducting/performing special reviews, risk assessments and internal reviews; coordinating external audits and investigations as required; reviewing legislative and federal audit reports and responses, and development of audit plans for corrective action follow up; reviewing external audits performed by outside agencies, e.g., HHS, CMS, OIG and follow-up as necessary; coordinating outside agencies’ audit requirements, e.g., entrance/exit conferences, work space, staff contacts, etc. for MHBE audits; and oversees contract administration activities and reports.

POSITION DUTIES

  • 25% - Use MHBE audit standards to perform external monitoring activities of contractors,including but not limited to, qualified health plans, connector entities, certified assistantssponsoring entities, producers, and vendors to promote their compliance with applicable 45 CFR155 and 156 standards.
  • 15% - Perform and/or assist in the performance of internal audits, compliance and privacyfunctions, monitoring activities and/or investigations pertaining to contracts, procurements or any other substantive complaints of fraud, waste and abuse of MHBE resources. Audit compliancewith federal and other billing requirements when the MHBE is the provider of services.
  • 10% - Collaborate with contract monitors to ensure they obtain and/or create appropriatedocumentation and/or metrics to support vendor compliance with contract and billingrequirements. In the event that non-compliance with a contract is found, support contractmonitors in the review of corrective action plans to ensure outcome metrics effectively measureimprovements.
  • 10% - Coordinate outside agencies’ audit requirements with MHBE personnel as required. External audits are performed routinely by various federal agencies as well as independent auditsbeing performed annually. These auditors require assistance in securing on-site work space,establishing initial program staff contacts, entrance/exit conference arrangements, obtainingdocumentation, update meetings, etc.
  • 10% - Review results of legislative and federal audit reports and other findings, and assist inpreparation of follow-up programs. Facilitate post audit reviews or studies to determine whetherthe recommended corrective actions have been implemented and/or maintained. Use statisticaltools to quantitatively analyze performance.
  • 10% - Prepare formal audit and compliance reports, which may include tables, charts, financialsummaries, schedules, workflows and written analyses, for the Director of Compliance andPrivacy. Such reports will include recommendations for corrective measures to mitigate re-occurrence and promote ongoing compliance.
  • 10% - Actively participate in the Compliance Committee and Program through coordination ofMHBE Program Director reports, development of data and reporting tools, and meeting materials.Represent the Compliance department in meetings, hearings, conferences, or any other activityas requested.
  • 5% - Assist in the development, implementation and maintenance of an effective audit programand associated audit manuals as well as guidelines to protect MHBE's resources from fraudwaste and abuse. Such material will conform to acceptable industry standards, (i.e. GenerallyAccepted Government Auditing Standards (GAGAS), Computer Matching Agreement, MARS-E).
  • 5% - Implement and maintain MHBE audit standards for the reviews of records and reports todetermine if they are in compliance with state and federal law.

MINIMUM QUALIFICATIONS

Education
  • A Bachelors degree in any discipline from an accredited college or university
Experience
  • Three (3) years of relevant healthcare compliance/auditing experience
  • Knowledge of current healthcare and ethics laws/regulations (e.g. The Patient Protection andAffordable Care Act (ACA), 45 CFR 155 Privacy and IT Security, 45 CFR 155 ExchangeEstablishment Standards, MARS-E v2.0, Md. Code Ann., State Gov't §§ 15-101 - Ethics Law)
  • Experience with preparing technical and non-technical reports, conducting investigations,reviewing and analyzing documentation, and managing cases
  • Experience creating and managing work plans with a strong attention to detail
  • Strong understanding of federal, state, and local regulatory processes
  • Outstanding interactive and leadership skills, and the ability to function in a team environment
  • Demonstrated ability to engage with a high degree of self-direction in analyzing issues,developing plans to resolve the issues, and implementing the resolution
  • Must be able to manage multiple priorities and projects with tight deadlines
  • Proficiency in Microsoft Office (Word, Excel, and PowerPoint)

SELECTIVE QUALIFICATIONS


DESIRED OR PREFERRED QUALIFICATIONS

  • Advanced degree in law, business or public administration, public health, or related field
  • Professional certification in corporate compliance or privacy (such as CHC, CHPC, CHRC, orother related certification)
  • Professional certification as a Certified Internal Auditor (CIA), Certified Fraud Examiner (CFE), orCertified Government Auditor Professional (CGAP)
  • Experience managing compliance, audit, and/or privacy program functions with regularperformance requirements, including reporting and presentation of findings to seniormanagement and/or outside stakeholders 
  • Specific audit experience within a health care, insurance, hospital and/or government operationsetting
  • Specific compliance experience within a health care, insurance, hospital and/or governmentoperation setting
  • Specific privacy experience within a health care, insurance, hospital and/or government operationsetting
  • At least one year of experience in a lead auditor role with demonstrated experience directingauditors
  • Experience in data analytics specific to designing, implementing, validation testing, andtranslating the analytics to audit reports

Conclusion

This is a Management Service position, and serves at the pleasure of the Appointing Authority.

SELECTION PROCESS

Please make sure that you provide sufficient information on your application to show that you meet thequalifications for this recruitment. All information concerning your qualifications must be submitted bythe closing date. We will not consider information submitted after this date. Successful candidates willbe ranked as Best Qualified, Better Qualified, or Qualified and placed on the eligible (employment) listfor at least one year.

EXAMINATION PROCESS

The assessment may consist of a rating of your education, training, and experience related to therequirements of the position. It is important that you provide complete and accurate information on yourapplication. Please report all experience and education that is related to this position.

BENEFITS

As an employee of the State of Maryland, you will have access to outstanding benefits, including: health insurance, dental, and vision plans offered at a low cost.

Click on this link for more details STATE OF MARYLAND BENEFITS

  • Personal Leave - new State employees are awarded six (6) personnel days annually (prorated based on start date)
  • Annual Leave - ten (10) days of accumulated annual leave per year
  • Sick Leave - fifteen (15) days of accumulated sick leave per year
  • Parental Leave - up to sixty (60) days of paid parental leave upon the birth or adoption of a child
  • Holidays - State employees also celebrate at least twelve (12) holidays per year
  • Pension - State employees earn credit towards a retirement pension
  • 401(k) – State employees can contribute to a supplemental Retirement Plan

FURTHER INSTRUCTIONS

The online application process is STRONGLY preferred. If you are unable to apply online, you may submit a paper application and resume:
  • via email: jasciel.stamp@maryland.gov
  • via mail: MHBE Office of Human Resources, 750 E. Pratt St, 6th Floor Baltimore, MD 21202
Resumes will not be accepted in lieu of completing the online or paper application. Applications must bereceived no later than the close of business on the closing date.

Appropriate accommodations for individuals with disabilities are available upon request by callingMDTTY Relay Service. TTY Users: call via Maryland Relay.

As an equal opportunity employer, Maryland is committed to recruiting, retaining, and promotingemployees who are reflective of the State's diversity. People with disabilities and bilingual candidatesare encouraged to apply.

We thank your Veterans for their service to our country and encourage them to apply.

This employer participates in E-Verify and will provide the federal government with your Form I-9information to confirm that you are authorized to work in the U.S. Employers can only use E-Verify onceyou have accepted a job offer and completed the Form I-9. If E-Verify cannot confirm that you areauthorized to work, this employer is required to give you written instructions and an opportunity tocontact the Department of Homeland Security (DHS) or Social Security Administration (SSA) so you canbegin to resolve the issues before the employer can take any employment action against you.




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