Paralegal, Regulatory Compliance

KabaFusion•Carrollton, TX

1d•$34 - $41

About The Position

Responsible for updating and maintaining the initial filings for all government payors (Medicare and Medicaid). Interpreting applications for Medicare and Medicaid, compiling supporting documents and analyzing the various requests prior to submitting these applications as well as fulfilling corporate filing functions. Responsible for monitoring, and providing support on a variety of complex federal, state, county and city regulatory licensing, compliance policies and procedures for the healthcare industry. Responsible for updating the maintenance filings to keep Medicare and Medicaid enrollments and associated permits active, and to ensure the timely submission of renewal forms and supporting documentation to regulatory agencies to guarantee revalidations. Responsibilities will also include assisting the Managed Care Department with ownership and disciplinary action review for a variety of Payers. Oversight of the maintenance of pharmacy profiles on NCPDP and NPI websites.

Requirements

Basic knowledge of business compliance regulatory framework.
Knowledge in all aspects of healthcare industry federal, state, county and city rules and regulations pertaining to the operations of home infusion pharmacies and home health agencies.
Excellent writing skills, ability to communicate effectively with branch managers and governmental agencies processing personnel.
Highly organized.
Excellent judgment and professionalism.
Ability to communicate with individuals at various levels.
Strong attention to detail.
Ability to handle sensitive information with discretion and utmost confidentiality.
Demonstrated ability to work with minimal supervision.
Ability to serve as a liaison with key internal stakeholders, Pharmacists in Charge, Nursing Administrators and Directors of Nursing, attorneys, and external organizations.
Superior ability to organize, prioritize, complete activities, and meet deadlines daily.
Continuously monitors changes and evaluates specific activities that may have an impact on the current licenses: including but not limited to relocations, change of ownership, company name changes, DBA's, and changes of Pharmacist in Charge, Nursing Administrators and Directors of Nursing. Submit documentation as required.
Proficient with computer applications, such as Windows, Excel and Word.
High School Diploma required.
Paralegal certificate required.

Nice To Haves

Bachelor's Degree preferred.
At least 2+ years State Board licensing experience preferred (Pharmacy or any healthcare entity).
At least 1+ regulatory compliance and/or credentialing experience preferred.

Responsibilities

Conduct research on the full nature of the application process for each entity and state.
Maintain and update the research to remain in compliance year to year.
Interpret and analyze the requirements of each application.
Compile the necessary supporting documents for each application.
Provide a thorough, detailed review prior to submission.
Support Medicare and Medicaid line of business for upcoming contract year business readiness.
Spearhead submission of Medicare/Medicaid Applications.
Assist in the development, implementation, and maintenance of annual timelines/work plans using contracting software to ensure timely and successful project completion including ad hoc projects.
Responsible for staying up to date with the latest communications and guidance provided by CMS as it relates to applicable projects.
Coordinate cross-departmental informational updates with Licensing, Managed Care and Reimbursement Teams – focusing on teamwork, information flow and supporting data to promote cross-training and unified team direction.
Develop and distribute internal communications regarding changes in Medicare and Medicaid.
Review/renewal of surety bonds and coordinate the issuance of the certificates of insurance.
Research special license projects and provide upper management with a comprehensive report outlining requirements, forms, application, regulations, timelines, fees, etc.
Prepare and submit revalidations; and any changes to Medicare and Medicaid (i.e., address change; PIC Change; officer change).
Complete and file Medicare 855S DMEPOS and 885B HIT applications.
Troubleshoot specific Medicaid issues and resolve accordingly.
Ensure enrollment processes are compliant with payer requirements for Government Health Plans.
Oversee the initial set up of user accounts with Government, Commercial Health Plans and Medical Group payer portals based on job function.
Assist the Licensing team with regard to permits for pharmacies and home health agencies at all levels: federal, state, county, and city, including but not limited to: State Board of Pharmacy, State Board of Nursing, Drug Enforcement Administration (DEA), and Business Licenses.
Oversee the updating of new licenses/permits, ensuring demographic and changes of ownership, location and Pharmacist in Charge (PIC), Nursing Administrator, etc. to the NCPDP and NPI websites.
Manage and submit ownership and disciplinary action disclosures as required for new/renewed credentialing and licensing applications.
Other duties as assigned.