Compliance Coordinator

What Will Your Job Look Like?

The Compliance Coordinator plays a vital role in ensuring MTM’s overall contractual compliance by partnering with various departments throughout the organization to develop and implement long-term compliance solutions.  A Compliance Coordinator is responsible for monitoring potential Fraud, Waste, and Abuse (FWA) by performing investigations, facilitating member appeals and transportation provider appeals, and overseeing the performance improvement plan (PIP) process for transportation providers.  The Compliance Coordinator also acts as a liaison and provides support to auditors as they review operational processes, policies and procedures, and contract management functions.  The Compliance Coordinator will help oversee Quality Improvement Plans, audits, provider assessment reviews, and assesses liquidated damages.

This is a hybrid of Work from home and 2 days in our Lake St.

Louis office.

What You’ll Do:


* Create contractual compliance monitoring tools and matrixes to ensure compliance metrics are sustained, follow best practices, and ensure all validation and quality requirements are met and documented


* Utilize large datasets to identify potential compliance deficiencies and monitor and maintain audits to reduce or define deficiencies


* Develop project plans, tracking and trending mechanisms to correct any identified deficiencies as well as identify focus areas for improvement to strengthen MTM’s Compliance Program


* Investigate and provide determinations to all member appeals and State Fair Hearing requests in accordance with contractual obligations using MTM and client protocols


* Read, comprehend, and apply contract document requirements, including application of contract verbiage and requirements for the operational processes of the organization


* Ownership and creation of PIPs for transportation providers by monitoring the dissemination of PIPs to transportation providers, including the progress made by transportation providers while actively on PIPs


* Facilitate internal audits including, conduct process reviews, conduct transportation provider focus audits, and document and report audit findings


* Own quality improvement plans and monitor progress to ensure compliance is achieved


* Assist auditors with external audits by providing support with audit tool completion, sample documentation compilation, and attending on site audits as needed


* Communicate information to Quality and Compliance Committee, Department heads and Executive Leadership; present findings as necessary to Leadership and external stakeholders


* Compile records, reports, investigation results, and audit findings as requested for external clients and state entities


* Monitor operational SLAs for Executive Leadership Team and identify risks for consideration


* Manage net promoter scores and satisfaction surveys for internal and external clients


* Provide reco...