Unique opportunity for a talented health plan compliance executive to build and lead the Compliance division within a growing multi-state health plan affiliated with one of the nation’s leaders in post-acute care
Reporting to the CEO, the Chief Compliance Officer is an integral part of the Executive Leadership team and will have overall responsibility for the strategic growth, oversight and operational leadership of the health plan’s Compliance program.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Implement and continually refine the Compliance Program. Develop and maintain compliance-monitoring tools as regulatory/contractual obligations change and make recommendations on proposed regulatory and policy changes.
Oversee and maintain compliance with contractual and regulatory obligations and State and Federal requirements.
Develop strategic relationships with and serve as primary liaison to respective government agencies for all matters related to compliance including all State and Federal agency audits.
Ensure compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation; recommending opportunities to strengthen the internal control structure.
Develop internal audit plan. Conduct and document internal audits of all business units to identify and correct areas of non-compliance.
Establish and maintain a solid culture of compliance throughout the organization. Develop Compliance training and education programs
Manage external regulatory audits. Organize, document and participate in all external audits. Support external auditors by coordinating information requirements. Ensure all documentation is timely delivered and properly maintained, auditing activities are documented and follow-up is prompt and accurate. Identify compliance issues that require follow-up or investigation.
Develop, implement, and document a master compliance auditing log. Disseminate written policies and procedures related to compliance activities.
Communicate audit progress and findings by preparing and presenting periodic compliance reports to executive leadership team and Board of Directors.
Delegation oversight administration and monitoring to include vendor and first-tier, downstream.
BACKGROUND/EXPERIENCE DESIRED
Education: Bachelor’s degree required, Master’s degree and/or Law degree preferred.
Skills/Abilities: The ideal candidate will have a proven track record of creating and managing a successful Medicare Advantage compliance program. 8+ years’ experience in managed care with Medicare regulatory compliance experience plus a minimum of 3 years in a senior management position required. ISNP experience very strongly preferred.
CONSULTANT
Tricia French RN, BSN
President & CEO
The French Group
(757)362-0202
[email protected]
