AVP, Compliance
About the position The AVP, Compliance is responsible for oversight and management of health plan or product compliance activities and serves as a resource on compliance issues. Provides leadership and expertise to help facilitate compliance with applicable federal and state statutes, regulations, contractual requirements, policies, and procedures to ensure product or health plan compliance.
Responsibilities
- Provides leadership, oversight and compliance expertise to senior leaders, health plan Compliance Officers and business units company-wide to ensure compliance with applicable laws, prevent and/or detect compliance risks and oversee remediation.
- Leads Compliance in facilitating external CMS audits, including inbound and outbound communications with the auditor, monitoring deadlines, quality control reviews of submissions, and providing compliance expertise to internal business teams in development of responses.
- Oversees Compliance as they provide internal support on state Department of Insurance audits, corrective action plans and tracking of key performance indicators.
- Professionally develops and coaches direct reports in creating goals that align with company priorities and providing support to help ensure success in their roles.
- Provides leadership on training and education of compliance requirements. Provides specialized compliance education and training when necessary.
- Promotes a culture of compliance and oversees day to day operations of the Health Plan or product Compliance program, the Compliance Plan, Code of Conduct and Anti-Fraud Plan.
- Assists the Compliance Officer with preparing written reports no less than quarterly to inform the Board of Directors, Compliance Committee, health plan Compliance Officers and senior leaders on the status of activities pertaining to overall compliance.
Requirements
- Bachelor's degree or equivalent combination of education and experience.
- 8+ years of Compliance Program Management or other related healthcare or legal experience.
- Previous management experience including responsibilities for hiring, training, assigning work and managing staff performance.
- Detailed knowledge of federal and state statutes, regulations, contract requirements and guidance that governs health insurance products and health plan issuer operations.
- Strong understanding of health maintenance organization plans, operational processes, and the ability to analyze issues, identify compliance risks and oversee timely and effective remediation.
- Ability to clearly articulate requirements and complex compliance issues to senior leadership, impacted business units, direct reports and external partners.
- Expertise with federal and state regulatory audit processes, and the ability to clearly and effectively communicate with auditors and regulators.
- Ability to build and maintain strong relationships with internal business units.
- Strong sense of ethics and integrity to ensure that the organization adheres to legal requirements and operates in a compliant manner.
- Ability to manage multiple projects simultaneously and be flexible and adaptable to change.
- Oversees and directs implementation and day to day operations of the Compliance program, Compliance Plan, Code of Conduct, and Fraud, Waste and Abuse Plan across the business while ensuring compliance with governmental and contractual requirements.
- Oversees and directs Compliance, Fraud, Waste and Abuse incidents response management process including investigation, mitigation, reporting, remediation, and training.
- Develops, maintains, and works within compliance department budget.
Nice-to-haves
- Master's Degree.
- 10+ years of Compliance Program Management or other related healthcare or legal experience with federal and state health insurance.
Benefits
- Competitive benefits and compensation package.
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