What are the responsibilities and job description for the Behavioral Health Compliance Manager position at WellSense Health Plan?
It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.
Job Summary:
Under the direction of the Senior Director of BH Programs and Strategy, this position supports the WellSense organization by working directly with the Compliance and Legal departments, as well as each functional area within WellSense, to ensure benefit compliance with Mental Health Parity rules. The position also supports the behavioral health team to ensure regulatory requirements across products by building and maintaining a compliance infrastructure (including creating and updating of databases and tracking logs).
Specifically, this position is responsible for maintaining business area awareness and competency specific to benefit parity within the structure of the Mental Health Parity and Addiction Equity Act through direct support and trainings on existing new requirements; manages BH program regulatory requirement compliance by working with the BH department as a whole to determine the implementation and operational impact of new laws, rules, benefits and regulations; and monitors federal and state laws, rules, regulations, manuals and transmittals and contract requirements. The position also supports external provider facing record audits as outlined by state regulatory requirements as needed.
Our Investment in You:
* Full-time remote work
* Competitive salaries
* Excellent benefits
Key Functions/Responsibilities:
* Serves as the internal WellSense Mental Health Parity key contact, supporting activities across all business teams.
* Promotes collaboration across organization specific to Mental Health Parity activities.
* Develops, tracks and maintains documentation to support overall Mental Health Parity compliance through working in a highly engaged manner with WellSense business units.
* Promotes and trains business units on Parity testing, supporting critical thinking to ensure alignment across benefits.
* Collaborates with Compliance and Legal teams to ensure business specific Mental Health Parity documentation and methodology is accurate and consistent across benefits.
* Collaborates with Compliance and other BH staff as the BH key compliance contact on all state and federal audit activity, including plan readiness, External Quality Review Organization activities and corrective action plans, as necessary.
* Develops and updates applicable BH operational policies and procedures to ensure compliance with all regulations affecting government products.
* Monitors changes to regulatory requirements and work with BH business subject matter experts (SMEs) to identify changes needed to mitigate risks, achieve compliance meeting the regulatory requirement.
* Works collaboratively with the BH team to develop and review internal audit plans, working to implement corrective action plans if applicable.
* May, as necessary, support the collection of data and analyze for regulatory reporting and filing, coordinate and develop reports, and assessment tools to verify compliance.
* May, as necessary, support the collection of external provider data and analyze for regulatory reporting and filing, coordinate and develop reports, and assessment tools to verify compliance.
Supervision Exercised:
* N/A
Supervision Received:
* General Direction is received weekly by the Senior Director of BH Programs and Strategy
Qualifications:
Education Required:
* Bachelor's Degree
Education Preferred:
* Master's degree in social work, Behavioral Health, Public Health, MHA, or related field
Experience Required:
* 5 years managed care, Medicaid and Medicare experience
* Knowledge of and experience with integrated (behavioral health and physical health) management, related business goals and practices within related areas.
Experience Preferred/Desirable:
* Knowledge of Medicaid plans and ACOs, and / or CMS and Medicare Advantage Prescription Drug Plans and Special Needs Plans
* Experience with health plan compliance activities
* Understanding of Mental Health Parity rules and tests
* Experience with Medicaid recipients and community services.
* Experience with data analysis
* Experience in project development and / or health policy.
* Lean Six Sigma training
Licensure, Certification or Conditions of Employment:
* Licensed Mental Health Counselor or another applicable licensure for MA preferred
* Successful completion of pre-employment background check
Competencies, Skills, and Attributes:
* Ability to be highly engaged with stakeholders, with demonstrated ability in leading/ facilitating cross functionally across the organization
* Effective collaborative and proven process improvement skills.
* Demonstrated ability to successfully plan, organize and manage high impact projects.
* Demonstrated ability to work independently and manage multiple projects simultaneously.
* Strong analytical and problem-solving skills.
* Strong oral and written communication skills; ability to interact within all levels of the organization.
* A strong working knowledge of Microsoft Office products.
Working Conditions and Physical Effort:
* Regular and reliable attendance is an essential function of the position.
* Work is normally performed in a typical interior/office work environment.
* No or very limited physical effort required. No or very limited exposure to physical risk.
About WellSense
WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.
Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees
