Compliance Analyst Electronic Visit Verification

Tempus Unlimited Inc•Stoughton, MA

2d•Hybrid

About The Position

The Tempus Electronic Visit Verification (EVV) Compliance specialist has a key role in supporting the state and the agency partners in ensuring PCA program participants are compliant with the use of EVV and the EVV policies. This role is responsible for implementing and overseeing the Tempus FI aspects of the EVV Compliance policies set forth by MassHealth and ensures Tempus FI satisfies contract requirements. This role involves a broad range of tasks including: preparing compliance reports and dashboards for the state, agencies and internal teams, monitoring EVV compliance metrics and supporting CMS-related reviews and compliance assessments, overseeing/initiating needed changes to the PowerBI dashboard, researching non-compliance cases, assisting with corrective action plans and/or process improvements, and communicating across departments, with MassHealth and other contracted agencies. This role and associated activities will evolve as EVV compliance requirements increase with the maturity of the implementation. Stoughton, Massachusetts office only First week in person for training Hybrid model observed after training

Requirements

Strong understanding of compliance governance, auditing and regulatory frameworks
Strong analytical capabilities to assess data and processes and articulate insights
Experience leading a process and implementing continuous improvement—including researching root causes and implementing changes
Ability to maintain and communicate in-depth knowledge of the MassHealth Compliance standards and regulations
Experience with data tools (Excel and PowerBI)
Methodical and diligent, outstanding planning abilities
Strong written and oral communication skills
Professional, friendly & understanding personality
Ability to work independently while functioning effectively as a team member
Self-motivated
Bachelor’s Degree required (Public Administration, Health Administration, Social Services, Business or related field)
5-7 years' experience in compliance, healthcare administration, Medicaid, home and community-based services or similar environment

Responsibilities

Serve as primary EVV compliance liaison between: EVV Project Leader EVV Reporting Analyst State program and policy teams EVV system vendor Call center and support operations Training and quality teams MassHealth PCM Agencies
Maintain and monitor EVV dashboard for EVV usage, program rules violations and other data trends
Monitor, prepare and share compliance reports for MassHealth and the agencies—which includes analyzing the data to ensure data quality, and to monitor common themes/trends
Prepare additional reports and present information, as needed, for senior leaders and MassHealth as necessary
Monitor the effectiveness of current compliance procedures and tools and lead the efforts to continuously improve to achieve the needed results e.g., identifying breakdowns and root causes and communicating and implementing changes
Support the development of any new EVV Standard Operating Procedures
Participate in EVV governance, change-control and system enhancement discussions
Understand barriers or root causes of why individuals are not compliant and drive remediation plans
Work with system vendor and EVV SME to resolve technical issues affecting compliance
Perform compliance-related research to answer questions or determine if an issue is non-compliant
Support requests received by MassHealth/Program Integrity Team
Support agencies and/or work in partnership with EVV Support
Support state-led outreach and communications related to EVV compliance expectations
Perform escalation follow-up for non-compliant individuals as necessary
Oversee the communication plan for EVV Compliance:
Draft, modify, and distribute EVV compliance communications
Send PCA non-compliance list to the EVV Support team who assist with PCA outbound calls
Create lists for Everbridge compliance messages and collaborate with IT to monitor the process.
Send address list to Mailing Department for warning letter preparation
Manage all incoming/outgoing EVV compliance-related emails and escalating any observed trends or case specific
Collaborate with the training and knowledge management teams to ensure EVV guidance is accurate and contract aligned
Provide EVV Compliance training to Tempus operations teams and other individuals as necessary
Review EVV job aids, FAQs, scripts and training content for compliance accuracy
Identify compliance risks and recommend process improvements to strengthen compliance and reduce/eliminate inefficiencies.