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Compliance Manager

The Compliance Program Manager will provide leadership to support the Compliance Director and Compliance Program to ensure business integrity and compliance with all federal and state laws, contract provisions, and internal policies/procedures. The Compliance Manager will also support the Compliance Director in managing the vendor oversight program to include monitoring, auditing, reporting, and following up with the business area to ensure processes exist to demonstrate compliance with delegation oversight requirements.

PRINCIPAL RESPONSIBILITIES

• Manage the vendor oversight program to ensure compliance with all regulatory requirements for the plan’s oversight of delegated functions including, but not limited to first tier, downstream and related entities (FDRs).
• Revises and develops audit tools to reflect current standards, contract changes, and regulations.
• Audits operational areas including FDRs to ensure compliance with regulatory requirements. Implements, manages and/or monitors corrective action for identified deficiencies.
• Provide written reports of delegation audit findings, present recommendations to the Compliance Director and Compliance committee.
• Assist the Compliance Director in the general development of the Compliance Program including, but not limited to, developing the Compliance Work Plan, Fraud, Waste and Abuse Plan and Compliance policy and procedures.
• Participates in the development of compliance training/educational materials and provides training as assigned, educating departments on specific compliance requirements.
• Serves as a resource and Compliance subject matter expert to highlight key areas of compliance risk and collaborates with internal and external stakeholders to put forth recommendations for process/system enhancements.
• Communicates with departments and FDRs to ensure consistent understanding of contractual, state, and federal regulatory requirements.
• Assists with conducting investigations involving instances of non-compliance.
• Prepares reports for the Compliance Committee, Board of Directors and other oversight committees as necessary.

POSITION REQUIREMENTS

• Bachelor Degree required
• At least 5 years’ experience in Medicare Advantage Prescription Drug Plans (MA-PD) or Managed Care regulatory compliance
• Advanced skills with MS Office tools (including Excel, Word, Power Point)
• High degree of interpersonal skills, problem solving abilities and excellent communication skills.
• Ability to review, analyze and interpret regulatory requirements in a clear and concise manner.
• Demonstrated analytical skills to assess and synthesize information; identifying key factors, trends and issues; identify and summarize possible risk and implications for the organization through assessments and audits.
• Project management and organizational skills to meet strict deadlines in an environment of multiple projects and changing priorities.

PREFERRED EXPERIENCE

• Minimum four years prior experience working with a compliance program desired.
• Prior experience in auditing in a healthcare organization.
• Preferred Licensure/Certification: Certificate in Healthcare Compliance

PHYSICAL REQUIREMENTS

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Physical Demands:

• Must be able to frequently sit, use finger dexterity, has good vision, hearing, and speaking to promote information exchange.
• Must be able to stand and use a copier, collate, staple, and bind large packets for meetings.
• Occasionally may have to lift boxes of office supplies and stack reams of paper on high shelves.
Mental Demands:
• Must be able to frequently problem solve, make decisions, interpret data, organize and analyze work flow, write, plan, and use simple arithmetic.
Working Conditions:
• Work is conducted indoors.
• Requires sitting at a desk in an office settings.
Major activities of the job include:
• Must be able to operate general office equipment including but not limited to: computer, phones, and related media and information devices.
Communication requirement:
• Must have the ability to communicate in writing, speaking, and hearing, both in person and/or by telephone.

This job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designated to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Management retains the right to add or change the duties of the positions at any time with or without notice.

Time:  Full time
Salary:  Salary
Category:  Compliance

Updated: 8/16/2018 4:35:29 PM