Compliance Officer - Exchange

Job Description

Job Description

Compliance Officer - Exchange

POSITION OVERVIEW

The Compliance Officer position is an executive position reporting directly to the President and is an active member of the senior leadership team.

This position is responsible for the oversight of all corporate compliance, related to Medicare and Medi-Cal, California Department of Managed Health Care (DMHC), and NCQA compliance.

This position has direct access to the Executive (Board) Committee for the purpose of advising and making recommendations about compliance issues or concerns.

RESPONSIBILITIES AND FUNCTIONS

· Supports the vision and direction of the company

· Oversees the development and maintenance of an effective Corporate Compliance Program, ensuring adherence to all regulatory requirements at the state and federal level, ensuring compliance with all aspects of CMS and Medi-Cal requirements.

· Leads the Compliance Committee that includes senior leaders within the organization to assist in the design, implementation and operation of an effective compliance program

· Establishes compliance policies and procedures, including the Corporate Code of Conduct.

· Ensure appropriate education and communication with employees to ensure heightened awareness of compliance requirements and avenues for reporting compliance concerns.

· Partners with department leaders to ensure compliance requirements are met, make recommendations for adherence and escalate issues of non-adherence to the President

· Oversees the development of internal audit, monitoring and assessment tools, as well as the evaluation process related to the effectiveness of the compliance function.

· Takes an active role in working with the Health Plans audit process

· Ensures companywide adherence to all regulatory requirements

· Responsible for establishing and monitoring all programs related to Privacy and HIPAA.

· Responsible for financial management of the department budget

· Responsible for supervision of direct reports to include performance management and evaluations.

· Support staff and provide the tools and resources they need to accomplish their goals which includes ensuring staff understand their roles and support staff in addressing issues that arise.

· Responsible for hiring, developing, training, mentoring and retaining high quality, productive employees.

· Manages projects related to Compliance in conjunction with inter- and intradepartmental staff · Assists in preparation for Health Plan audits, responding to auditor’s inquiries and preparing responses to auditors’ findings

Level of Education

Bachelor’s Degree required.

Juris doctor or Masters’ degree in a health care field preferred.

Certification in Health Care Compliance preferred.

Eight (8) years’ experience in managed health care.

Five (5) years’ experience with Medicare, Medi-Cal, and commercial lines of business.

CMS audit experience also strongly preferred.