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Date Last Verified
Years of Experience
ProfileVice President, Compliance The candidate will ensure regulatory compliance with state and other government agencies related to the health insurance industry, Firm, and its business subsidiaries. Will ensure business unit and Centene Corporate are in compliance with state and federal program regulations, insurance regulations, regulatory requirements for business entities and state contract requirement. Maintain and track laws and regulations, contract documentations, amendments, and various compliance measures. Develop policies, procedures, and processes to comply with state law, federal law, contract requirements, and various standards. Oversee, administer, and implement various compliance programs, including fraud and abuse and HIPAA. Provide guidance to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language. Conduct compliance audits, develop and implement corrective action plans, and report on achievement of action plans to senior management and Board of Directors. Develop strategic relationships with state legislative policymakers and assist with the development of state legislative public policy concerning state insurance, Managed Care Organization, Medicare and Medicaid regulations and initiatives. Identify, evaluate and analyze the impact of state legislative and regulatory issues and advise management concerning impact. Represent senior management at various committees, meetings, and seminars
Qualification and Experience
The candidate should have Bachelor's degree in Public Policy, Government Affairs, Business Administration or related field. Must have 8+ years of compliance program management and contract experience. Extensive knowledge of state administrative code and regulations, state insurance laws and regulations including managed care regulations is essential. Experience with state and federal government agencies, accreditation bodies, participating provider agreements, HIPAA and Third Party Administration (TPA) laws, credentialing regulations and prompt pay laws is essential. Masterâ€™s or Law degree is preferred.
7700 Forsyth Blvd.
Saint Louis, MO 63105