Manage the compliance department functions, including but not limited to, periodic monitoring and auditing activities based on established compliance program, policies, and practices to ensure and maintain compliance with federal, state, and local regulatory, contractual and legal requirements.
- Manage approval and submission of timely and accurate contract and regulatory required report deliverables
- Oversee all contracts updates including creating new and updating existing contracts with Health Plans, States and consultants/vendors
- Conduct periodic assessments to ensure compliance against contract requirements
- Oversee creation and implementation of corrective action plans to reduce or eliminate risk resulting from non-compliance with contract requirements or performance deficiencies
- Collaborate with Health Plans and States, where applicable, to maintain/improve customer satisfaction specific to delegated functions and compliance with contract requirement.
- Manage submission of consumer and provider communication materials, including participation in their review and timely submission to Health Plans and States, where applicable
- Manage composition and delivery of responses to state regulatory agency complaints and inquiries
- Determine licensure requirements and administration of ongoing licensure maintenance, including research in new markets and timely filing for recurring deliverables, such as licensure renewals
- Support responses to “ request for proposals” (RFPs) and new business implementations by completing assigned compliance tasks timely and accurately
- Participate in new business implementations, including the identification and tracking of required contract report deliverables as well as new reporting and provider/member materials.
- Design, implement and improve processes to prevent, detect and respond to compliance issues and concerns related to all federal and state regulatory requirements and contract requirements.
- Create and deliver compliance training for all employees on an annual basis and as needed basis, such as in response to a compliance issue or concern
- Bachelor’ s degree in health care administration, compliance or related field or equivalent experience.
- 4-6 years of compliance experience including risk assessment against contract and regulatory requirements, creation and execution of auditing, monitoring and reporting processes, administration of correction action plans, implementation of written policies and procedures, developing and delivering compliance training and education.
- Managed health and/or behavioral health experience preferred.