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Years of Experience
Date Last Verified
ProfileHead of Medicare Business Support (Compliance Director) Duties: Reports to the Medicare/Medicaid Chief Compliance Officer (“MMCCO”). Responsible for leading all the day-to-day compliance initiatives and workstreams that focus on business lines and contracts – a critical component of the business unit’s overall Compliance Program. Responsible for helping to set an appropriate “Tone at the Top” of the organization and cultivating a culture that emphasizes integrity; a working atmosphere that promotes open and candid discussions regarding compliance concerns; acceptance of responsibility for actions taken; effective compliance oversight; and operational transparency with key stakeholders, including customers and government clients. Set a collegial tone and operate as a thought partner with business leaders, Compliance colleagues and other in-house professionals, including those in Internal Audit, Legal, Human Resources and Information Security. Ensure that compliance team understands the operational nuances and realities of the Medicare business, and that pertinent regulatory requirements and developments are communicated in a timely manner to the impacted business partners. Provide constructive advice and guidance to facilitate the successful operation of Medicare business. Assists the in preparing periodic reports to the Global Chief Compliance Officer and the Audit Committee of Board of Directors; Develops an effective system for ensuring that relevant legislative, regulatory, enforcement and administrative developments are reviewed promptly, analyzed carefully and communicated to the relevant business leads in a constructive manner; At the direction of the MMCCO, serves as one of the Compliance Department’s lead representatives with Medicare regulators; Identifies policy, regulatory and enforcement trends that might affect the Medicare business, and communicates that advice to the impacted in-house resources; Escalates, as warranted, instances of potential non-compliance to the MMCCO; Supports the Compliance Director in charge of FDR oversight; In cases of possible non-compliance, helps oversee the performance of root cause analyses and assists colleagues in the Corrective Action Plan Monitoring Unit with the development and implementation of any needed corrective action plans; Working with the Head of Compliance Communications, ensures that appropriate policies and procedures are adopted and periodically reviewed and, as warranted, revised. Provides appropriate support in the bid development and submission process; and Provides support in internal and external regulatory and enforcement audits.
Qualification and Experience
Qualifications: Bachelor’s degree. JD Degree or Master’s Degree and certificate in healthcare compliance strongly preferred. 8+ years’ experience as a compliance professional in positions of increasing responsibility, with a minimum of five years of experience with the Medicare program. Strong preference for experience in the corporate setting and/or in a relevant federal or state agency (e.g., the Centers for Medicare & Medicaid Services). Experience interacting effectively with federal and state regulators and enforcement agencies. A demonstrated commitment to integrity, regulatory compliance and ethical decision making. Consistently sound judgment and incisive, three-dimensional analytical abilities. Outstanding verbal and written communications skills. Ability to lead a team effectively in a fast-paced environment. Strong, independent decision-making ability – leads by example. Intellectual flexibility – adept at reassessing priorities to ensure that internal and external expectations are fulfilled. Attention to detail, ability to compile and analyze regulatory and business information, determine cost/benefit, and provide possible resolution strategies or recommendations for process improvement. A highly collaborative individual with ability to influence others and build strong professional relationships. Requires a customer-focused and creative approach to problem solving and the ability to efficiently manage a substantial number of issues. Strong ability to navigate through barriers to drive initiatives throughout the business.