Associate Director, Compliance(Must Live In Indiana, Preferred Experience In Managed Care)

CareSource

About The Position

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

Requirements

Bachelor’s Degree in Business/Healthcare Administration or a related discipline, or equivalent years of relevant work experience are required
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
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
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)

Nice To Haves

Masters of Business Administration (MBA), Juris Doctorate or other advanced degree, is preferred
Certified in Healthcare Compliance (CHC) preferred

Responsibilities

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