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Senior Director - Projects The candidate will develop and manage a detailed and robust compliance program for all health care lines of business, including Medicaid, Medicare Advantage, and Medicare Part D, and the Privacy program. Lead the implementation of new health care laws and regulations that bring into compliance. Reviews the company's operational and compliance policies and procedures for adherence to SOPs. Must possess the ability to Interpret and communicate pending and adopted legislation and regulations to the appropriate departments in the company. Will manage a key set of compliance Service Level Achievements (SLAs) metrics for the various account clients based on internal auditing, self-reporting, data gathering from the operational towers and monitor the analysis of compliance metrics. Must handle responses and corrective action plans for internal and external audits. Work with delegation and vendor oversight departments to ensure that state and federal exclusion reviews occur for first tier entities, downstream entities, and related entities. Run the oversight of required account level compliance training programs to ensure that officers, directors, managers, employees, agents, contractors, and other individuals working on the Medicare, Medicaid and other related programs, are knowledgeable about the companyâ€™s account level compliance and anti-fraud program; its written standards of ethics and conduct, operational policies, and procedures; and applicable statutory and regulatory requirements. Develop and manage oversight metrics to ensure that first tier entities, downstream entities, and related entities under the companyâ€™s vendor and FDR programs, are aware of and follow the state and federal requirements. Manages compliance with federal and state contracts for services on behalf of Medicare, Medicaid, and commercial beneficiaries. Lead and ensure the Compliance Committee meetings occur. Regularly report on issues, the status of the compliance program, the identification and resolution of potential or actual instances of non-compliance and required compliance training, within the Corporate Compliance Committee. Respond to alleged violations of rules, regulations, policies, procedures, and standards of conduct by evaluating or recommending the initiation of investigative procedures. Develop and oversee a system for uniform handling of such violations. Will perform other duties as assigned and required. Must have 12+ years of relevant compliance, legal and operational experience. Experience working for a global, multinational, corporate business environment or Pennsylvania health care operations and compliance experience are preferred. Relevant compliance related qualifications are highly desirable and expected. Minimum Bachelorâ€™s Degree required, Masterâ€™s Degree in Health Care, Business, JD degree, or other subject matter is preferred. Certification in Health Care Compliance or Compliance is preferred (e.g., CCEP, CHC, etc.).
Job ID: 00028362651
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