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Carrot Peelers, Sales, Personality and Your Job Search
In-House
Attorney
Health Care
Litigation - Whistleblower - CFTC
Min 3 yrs required
Medicaid Healthplan Compliance Officer (Associate Director) Duties: Responsible for supporting all aspects of the compliance program for Medicaid Healthplan. Reports to the Regional Director of Compliance and indirectly to Plan Leadership, and serves as a first point of contact for state regulators on compliance matters related to the plan. Provides leadership to and is accountable for the performance and results through multiple layers of management and senior level professional staff. Monitor changes to laws and regulations to ensure compliance with State & Federal laws, regulations and mandates. This individual will develop, implement and maintain the compliance program within Community & State Operations in order to ensure that we are meeting company guidelines and CMS requirements. Will establish and implement standard policies, procedures, processes and best practices across Group to promote compliance with applicable laws and contractual obligations. Will conduct state-specific legal research and monitor changes to requirements to mitigate risks and achieve compliance. Will support the collection of data for regulatory filings, coordinate and develop reports, projects, and assessment tools to verify compliance. Will develop compliance communications and drive problem resolution for a business. Develop and manage site Compliance Committee meetings. Ensure written standards and procedures. Provide training, communications and education. Ensure proper reporting and response to state stakeholders. Conduct auditing and monitoring, to ensure compliance. Oversee contract compliance activities and vendor oversight. Remain vigilant regarding fraud, waste and abuse. Ensure privacy within the healthplan.
Qualification and Experience
Qualifications: Bachelor’s degree or equivalent experience. Preferred Master’s degree or J.D. Degree. Certification as a Healthcare Compliance Professional (HCP). 3+ years of experience in a role directly managing a compliance program. 3+ years of experience and knowledge working with the Michigan Medicaid. 3+ years of experience and knowledge working with state level regulators. 3+ years of experience and understanding of HIPAA and state privacy laws. Experience in a strategic role, ideally leading and implementing a comprehensive compliance program. Experience developing and presenting training programs. Solid experience in managed care and government programs. Experience leading audits and major program initiatives. Experience developing relationships with regulatory agencies. Experience managing multiple projects/tasks; proven history of successful results in managing issues and driving strategic program initiatives. Experience working as a Subject Matter Expert in a large, highly-matrixed organization, working with various business segment and/or stakeholders. Experience in a Medicaid regulatory or compliance role, will have experience working with state level regulators, will have experience working with OIGs, and will have strong project management experience and experience working in a matrixed environment.
Ref-583453
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