Job Summary:
The Associate Director, Compliance is responsible for establishing a baseline of compliance risk, identifying areas of potential exposure, developing and aligning compliance risk management strategies with CareSource goals and objectives, and executing the compliance program ensuring effectiveness.
Essential Functions:
- Serves as the program compliance leader for an assigned Medicaid, Medicare, or Marketplace CareSource program and will be responsible for building and maintaining a strong relationship and goodwill with the relevant regulatory entity
- Assist the Program or Regional Compliance Officer and their designees with the implementation of an effective compliance program
- Oversee all assigned program compliance activities performed and tracked by compliance staff including, but not limited to, internal business owner and external regulator inquiry management, State complaint management, regulatory distribution management, and compliance workplan execution
- Build and maintain strong partnerships with business units and internal support functions to help ensure that all compliance requirements have been met; risk is monitored and remediated through testing/ development/ implementation and use
- Remain current and help drive interpretation and implementation of federal/state laws and regulations regarding Medicaid, Medicare and Marketplace requirements, as applicable, as well as general compliance and delegation oversight best practices and industry standards
- Provide feedback to Compliance leadership concerning key risks in assigned program so that Compliance leadership may complete the annual compliance risk assessment
- Assist with the execution of the compliance work plan
- Respond to compliance incidents and ensure appropriate reporting and communication with business leaders and compliance team members
- Manage and drive effective usage of compliance tools and data for the compliance tracking systems
- Track and trend issues to identify compliance risk and performance improvement opportunities; provide input for executive compliance reporting
- Assist with regulatory audits and drive audit readiness activities for assigned program
- Assist teams in interpreting audit findings against audit findings, prepare and complete audit responses and oversee the development of effective corrective actions
- Act as a resource for internal departments to assist with external-entity related escalated issues
- Identify compliance knowledge gaps and collaborates with applicable business teams to develop training programs to address the gaps
- Collaborate with internal resources on the production and communication of compliance related alerts, newsletters and educational materials for company workforce
- Establish effective working relationships and build creditability within the organization to support a culture of compliance based on the company's core values
- Report potential risks, non-compliance or alleged violations to Compliance leadership and plan leadership
- Provide management and oversight of professional staff
- Perform any other job duties as requested
Education and Experience:
- Bachelor’s Degree in Business/Healthcare Administration or a related discipline, or equivalent years of relevant work experience are required
- Masters of Business Administration (MBA), Juris Doctorate or other advanced degree, is preferred
- A minimum of five (5) years of relevant work experience within health plan operations is required, with at least three (2) years directly involved in government programs or managed care compliance activities preferred
- Two (2) years of direct management experience is required
- Specific Marketplace, Medicare and Medicaid managed care experience is required as applicable
Competencies, Knowledge and Skills:
- Advanced capabilities in MS Office suite including Microsoft Word, Excel and PowerPoint
- Ability to develop and foster effective collaborative relationships with market and enterprise management in a matrix environment
- Strong conflict resolution, negotiating and influencing skills
- Excellent relationship management skills that will build and maintain strong working relationships in a matrix environment and influence action across the organization around risk management
- Knowledge of managed care principles, benefit design, claims processing, finance, data reporting design, and analysis
- Leadership ability with a high level of professionalism
- Excellent oral and written communication skills
- Ability to effectively interact with all levels of management within the organization and across multiple organizational layers
- Excellent analysis, attention to detail, and collaboration skills
- Ability to deal with ambiguity - integrate, prioritize and rollout programs without clearly defined guidelines
- Experience in a high-growth business environment
- Working knowledge of health plan environment is preferred
- Strong analytical skills, effective problem-solving skills, and attention to detail
- Ability to work in a fast-past environment
- Ability to develop, prioritize and accomplish goals
- Knowledge of regulatory environment and regulators (CMS/HHS/DOI/ Medicaid)
Licensure and Certification:
- Certified in Healthcare Compliance (CHC) preferred
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$113,000.00 - $197,700.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
Originally posted on Himalayas