Compliance Analyst Electronic Visit Verification (Stoughton)

Position Title: Compliance Analyst Electronic Visit Verification
Location: Tempus Corporate Headquarters, 600 Technology Center Drive, Stoughton, Massachusetts, United States of America
Requisition Number: Req #290

Job Description

Tempus Unlimited, Inc. is a nonprofit organization that provides community-based services to empower children and adults with disabilities to live as independently as possible in the least restrictive environment. The agency, through its programs and services, encourages the inclusion of people with disabilities into the mainstream of society, including social, recreational, family and work activities.

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

Essential Job Functions

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

Analytics

• 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

Operations

• 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

Research Escalations and Support Communications

• 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

Training

• 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

Risk Management

• Identify compliance risks and recommend process improvements to strengthen compliance and reduce/eliminate inefficiencies.

Competencies

• 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

Qualifications

• 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

Work Environment

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, and scanners.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is regularly required to talk and/or hear. The employee is frequently required to sit; stand; walk; use hands and fingers and also must be able to reach with hands and arms. Must be able to lift up to 15 pounds at times.

Travel

Travel may be required for this position.

Other Duties

Note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Benefits

Tempus Unlimited offers great benefits that foster a happy fulfilling human work experience. We also have an array of growth opportunities for our employees to develop your career and enhance your experience.

• Sign on bonus
• Work/Life Balance
• Paid time off - 25 days per year for full time staff
• 14 paid Holidays
• Tempus Wellness - Medical, Dental, Dependent Care Reimbursement, FSA and HSA
• Basic Life, Short Term and Long-Term Disability
• On-site gym (Stoughton Location) and wellness initiatives
• Annual Reviews with merit-based increases
• Employee Recognition Program
• Financial Wellness - 403(b) Retirement Plan with matching
• Continuing Education, Training and Advancement opportunities

Work Authorization/Security Clearance

All offers of employment made by Tempus Unlimited are contingent upon satisfactory background check results. Pre-employment background checks will be conducted on all candidates that are offered a position at the agency in compliance with program policy as well as state and federal regulations. From time to time, these checks may be conducted on current employees to ensure compliance]]>