Job Description

Job Description

Job Description

Medicaid NEMT Compliance Officer Job Description

Job Title: Medicaid NEMT Compliance Officer
Department: Risk Management / Compliance
Reports To: VPTA Executive Director

Join VPTA's dynamic team as our NEMT Compliance Officer and become a vital link in providing exceptional healthcare transportation experiences to fellow Vermonters. In this energetic role, you will provide statewide oversight program-compliant support to the public transit providers throughout Vermont. Your enthusiasm and customer-centric approach will help transform complex medical travel processes into the best experience possible. This role is perfect for motivated individuals eager to make a meaningful difference by keeping up with regulatory and program changes and implementation.

Position Summary

The Medicaid NEMT Compliance Officer ensures that all Non-Emergency Medical Transportation (NEMT) operations comply with federal, state, and broker regulations. This role focuses on risk mitigation , prevention of fraud, waste, and abuse (FWA), and maintenance of data integrity to meet Vermont Medicaid (DVHA) program requirements and billing. The position requires strong interpersonal skills and the ability to work effectively with all levels of the organization. The Compliance Officer works closely with VPTA executive leadership and the training and data management teams.

Responsibilities include auditing, investigating, implementing training/education and enforcement, and ongoing consultation on compliance issues affecting VPTA’s business. Ongoing monitoring and reporting on adherence to compliance controls, recommending and supporting transit providers to implement necessary compliance controls. This includes the production of scorecards, metrics, and process plans to ensure full program compliance. This candidate must have strong interpersonal skills, with the ability to work effectively with all levels of the organization. The required skill set includes excellent verbal and written communication skills, as well as strong analytical, organizational, planning, and problem-solving skills.

Essential Duties and Responsibilities

Regulatory Compliance & Policy Management

• Regulatory Alignment: Align operations with Centers for Medicare & Medicaid Services (CMS) guidelines and Vermont state-specific Medicaid NEMT manuals.
• Policy Development: Draft, update, and implement internal compliance manuals, operational policies, and codes of conduct.
• Broker Requirements: Ensure full adherence to specific rules set by VPTA (VT Medicaid’s NEMT broker)

Core Responsibilities

• Regulatory & Contractual Adherence: Ensures compliance with CMS regulations, state Medicaid guidelines, and external broker contracts
• Audit & Quality Assurance: Conducts internal audits of Vermont State NEMT Program requirements, including reporting metrics and billing data.
• Corrective Action Plans (CAPs): Design and execute CAPs when operational deficiencies or external audit failures are identified.
• Fraud & Abuse Prevention: Monitors transport claims for accuracy, ensuring services billed match services rendered with support of VPTA’s data management.
• Policy & Training: Develops and updates company policies and oversees compliance training.

Qualifications & Skills

• Experience: Typically requires 5 years of NEMT compliance, Medicaid experience, or NEMT industry experience.
• Education: Bachelor’s degree in healthcare administration, business, or a related field, with extensive experience.
• Technical Skills: Proficiency with NEMT dispatch software and claims billing portals.
• Knowledge: Strong understanding of HIPAA, 42 CFR Part 440.170, and state-specific Medicaid NEMT requirements.
• Soft Skills: Strong analytical, record-keeping, and problem-solving skills, with the ability to reconcile complex billing. Strong interpersonal skills, with the ability to work effectively at all levels of the organization.

Salary and Benefits:

Base Salary is commensurate with experience, with a target range of $90,000 – $115,000, plus a comprehensive benefits package.

• 401(k) 3% Match
• Dental insurance
• Health insurance
• Life insurance
• On-the-job training
• Opportunities for advancement
• Paid time off
• Vision insurance

This position will require extensive travel, a valid driver's license, and the ability to pass extensive background checks.

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