About Roadrunner Food Bank of New Mexico
Roadrunner® Food Bank of New Mexico, a Feeding America member, is the largest non-profit dedicated to solving food insecurity in New Mexico. As a food distribution hub, we provide food to hundreds of affiliated member partners around the state including food pantries, soup kitchens, shelters and regional food banks. We also distribute food through specialized programs helping children, families and seniors at schools, low-income senior housing sites, senior centers and with and through health care partnerships. Every week, tens of thousands of hungry children, seniors and families are reached through this statewide hunger relief network. We are working together with our partners, volunteers and contributors to end food insecurity and hunger in New Mexico.
About Our Compensation & Benefits
As the leading non-profit fighting hunger in our state, we believe that it is important to take care of the people who come to join us in that fight. As such, we maintain transparent salary ranges. You can expect us to offer the best salary up front with no room for negotiation. Once hired, employees have the opportunity to progress through salary ranges via regular merit increases and step promotions. Additionally, we embrace a Total Rewards philosophy and offer a second-to-none benefits package. We pay 85% of the medical, dental, and vision insurance premiums for employees, and 75% for their dependents, including domestic partners. The majority of our employees pay less than $60 per check for medical insurance. We also offer life insurance, short-term disability insurance, long-term disability insurance, 403(B) retirement plan, AFLAC, LegalShield, identity theft protection, and pet insurance.
About This Opportunity
If you're passionate about protect patients and ensuring organization integrity and want to work in a challenging, highly rewarding field with a unique mix of high-level problem-solving, legal application, and direct impact on quality of care, this position may be perfect for you!
Position Overview
This position provides direct support to the Chief Impact Officer by providing all administrative and technical assistance to implement, manage and oversee the Medicaid reimbursement, HIPAA and other contractual obligations necessary to maintain compliance. This position will work as a liaison to the Roadrunner Food Bank Finance Team as afront-end contact for team members who are being billed for reimbursements.
Essential Duties and Responsibilities
- Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.
- Designs, implements, monitors, audits, and evaluates systems that ensure regulatory compliance and continuous performance improvement
- Serves as a liaison with internal and external stakeholders (e.g., regulatory agencies, auditors, community partners) to represent organizational quality and compliance efforts
- Oversees internal auditing activities to ensure adherence to quality standards, regulatory requirements, and organizational policies with Finance Team
- Participates in local, state, and federal audits, ensuring timely preparation, response, and follow-up with Finance Team
- Oversees the incident reporting process and, in collaboration with the Chief, conducts investigations and recommends corrective actions
- Collaborates with organizational leadership to develop, implement, and monitor department-specific quality improvement, compliance, and risk management plans
- Stays up to date on local, state, and federal healthcare regulations, accreditation standards, and payer requirements, and interprets their impact on organizational policies and practices
- Leads organization-wide quality improvement initiatives by identifying trends, gaps, and opportunities for improvement; sets measurable goals and tracks progress toward outcomes
- Develops dashboards and reports to monitor compliance and quality metrics; presents findings to leadership and committees to drive evidence-based decisions
- Develops and delivers organizational HIPAA training and ongoing compliance education for team members and, as appropriate, partner organizations
- Mentors team members on best practices in compliance and quality management
- Serves as a technical resource to team members for needed reporting, data collection, and quality metrics
- Prepares quarterly reports to inform leadership on the status of activities pertaining to overall compliance for areas of responsibility.
- Translates Finance to Healthcare/Tech and back internally
- Technical oversight of PearSuite and Closed Loop Referral System(s)
- Maintains compliance with insurance requirements
- Provides Health Plans or Payors with evidence of insurance
- Participates in Health Plans’ and Payors’ Utilization and Quality Management
- Participates in annual HEDIS audits
- Maintains infrastructure to mitigate fraud, waste, and abuse
- Responds to members’ complaints and grievances with the Health Plans and Payors
- Manages arbitration proceedings with legal counsel as necessary
- Manages compliance with neglect, abuse, and exploitation policies
- Ensures all rendering providers maintain their credentialing, licensure, CEU’s, insurance, and periodic required training with the Health Plans or Payors (i.e. cultural sensitivity training) in coordination with People & Culture Team
- Organizes periodic HIPAA training for employees and compliance with HIPAA and HITECH federal and state laws in coordination with the People & Culture Team
- Manages Corrective Action Plans as required or initiated by Health Plans and Payors in coordination with the People & Culture Team and supervisors where appropriate
- Submits reports and encounter data to the Health Plans or Payors timely
- Manages support in the transference of members to other Health Plans or Payors
- Manages prior authorizations for Community Health Worker services, if needed
- Provides Health Plans or Payors with Provider information within 5 days for Provider Directory maintenance
- Notifies the Health Plans or Payors within 7 days of any provider suspension, revocation, or restriction of licensure
- Oversight of the returning and destroying of Confidential information within 30 days of termination of agreement with any Health Plan or Payor
- Notifies Health Plans or Payors of intent by a member to file a claim or intent to commence action within not more than 10 days
- Manages medical records in compliance with federal and state laws, regulatory bodies, and MCO requirements
- Responds to member or Health Plans and Payors medical records requests within 2-10 business days of requests
- Provides medical records to the Health Plans or Payors, HCA, CMS, OSI, and other regulatory bodies
- Requests claim filing extensions beyond 90 days
- Responds to Health Plans’ or Payors’ amendments to the contracts, provider manuals, or fee schedules within 30 days of notice
- Ensures compliance with periodic audits (at times monthly) to ensure providers are in compliance with all federal and state laws including review of the HHS Office of Inspector General List of Excluded Individuals and Entities
- Keeps up to date on the Medicare Improvements for Patients and Providers Act (MIPPA)
- Fosters relationship with internal Finance team to ensure team communication and alignment on compliance activities, roles & responsibilities
- Assists Chief in developing and presenting training to staff on compliance processes and procedures.
- Keeps up to date on all current compliance regulations, specifically those regarding Medicaid reimbursement, current healthcare partner contracts and HIPAA
- Translates technical information to accessible, usable policies and procedures
- Participates in high-level/technical components of Closed Loop Referral System(s) by participating in the New Mexico Social Determinants of Health Workgroup
- Maintains excellent customer service relations with all internal and external customers
- Demonstrates a commitment to the mission of Roadrunner Food Bank and its internal “Culture of Possibilities”
- Performs all other job-related duties as assigned
Competencies
- Strong leadership, strategic thinking, and decision-making capabilities
- Strong analytical and problem-solving skills
- Project management experience
- Knowledge and ability to think creatively, proactively, and independently
- Ability to prepare reports and presentations and manage data
- Self-motivated and results oriented
- Strong organizational skills and the ability to meet delivery targets
- Disciplined and ability to effectively track, document and report on projects/activities
- Ability to work collaboratively across functional teams and amongst diverse people and groups
- Strong oral and written communication skills; ability to interact professionally with the public
- Ability to think strategically and to resolve problems; strong strategic planning, organizational, and negotiating skills and comprehensive experience in customer service management required
- Computer literacy and data entry skills required
- Extensive knowledge of relevant regulatory frameworks and industry standards
- Highly organized with superior attention to detail and excellent follow-up skills
- Ability to think strategically and to resolve problems
- Ability to work collaboratively across functional and programmatic teams and amongst diverse people and groups
- Excellent written, verbal, and interpersonal communication skills, including group facilitation skills
- Positive attitude and ability to work as part of a team
Work Environment
- Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.
- This is an in-person position with limited ability to function as hybrid or remote
- Work is performed primarily in an office environment using standard office equipment
- Extensive computer operation with repetitive finger movement
- Noise level is typically moderate
Physical Demands
Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.
- Prolonged periods sitting at a desk and working on a computer
- Must be able to remain in a stationary position for extended periods, often 50% or more of the workday
- Frequently operates a computer and other office machinery. This involves using hands to finger, handle, or feel objects and controls
- Requires the ability to use fingers to grasp, move, or assemble small objects
- Needs to be able to clearly communicate verbally and understand others, both in person and by phone
- Must be able to move about the office to access files, machinery, and other areas
- Occasionally needs to lift and carry items such as boxes of paper, files, or supplies, typically up to 10-25 pounds
- Must be able to reach with hands and arms, placing items above, at, or below shoulder height
- May need to stoop, kneel, or crouch to file or retrieve items
- Frequently pushes or pulls objects like file drawers
- Ability to see details of objects at a close range and, less importantly, at a distance
- May need to ascend/descend stairs or move between work locations
- Walking short distances
- Bending, stooping, twisting
- Reaching above and/or below shoulder
- Handling/grasping documents or office equipment
- Sitting and/or standing for short or extended periods of time
- Clear speaking and adequate hearing sufficient to communicate effectively and respond appropriately in person and/or on the telephone
- Vision sufficient to read source materials and computer screen data
- Repetitive motions for computer equipment use
Travel Required
- Infrequent travel required (less than 25% of working time)
- In-state travel only, primarily confined to the Albuquerque, NM and Las Cruces, NM metro areas
- Overnight stays are rare
- Company vehicle provided for travel
- Mileage reimbursement is provided for the use of a personal vehicle for work-related activities
- Valid state driver’s license and continuous positive MVRs (Motor Vehicle Reports) are required to drive RRFB company vehicles
Required Education, Licenses, Certifications, and Experience
- Bachelor’s Degree (preferably in public health, nutrition, social work, or related field), or equivalent work experience
- 5 years of experience in compliance, risk management, and/or auditing, or equivalent combination of relevant education and experience
- At least 3 years management/leadership experience
- Experience developing and implementing compliance programs and controls
Preferred Education, Licenses, Certifications, and Experience
- Previous experience in a health plan or government programs setting (Medicaid, Medicare, Marketplace)
- Certificate in Healthcare Compliance (CHC), or other compliance-related certification
- Experience in in hunger relief, food access, community building or advocacy, or community health
Work Authorization/Security Clearance Requirements
- Legally Authorized to work within the United States
Disclaimers
Affirmative Action/EEO Statement
Roadrunner Food Bank is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, or veteran status.
E-Verify Statement
Roadrunner Food Bank participates in the E-Verify program.
Other duties
Please 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.
This position description in no way states or implies that these are the only duties to be performed by the employee in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give assignments.
This role description excludes the marginal functions of the position that are incidental to the performance of fundamental job duties. All Key Result areas are essential job functions and requirements. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. This document does not create an employment contract, implied or otherwise, other than an "at will" relationship.
