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Vice President of Compliance

Job Posting
Vice President of Compliance
Job Details
Job Type

Full-time

Greensboro, NC • Compliance
Description
Job Summary

Reporting to the CEO, the Vice President of Compliance will serve as a leader and role model for ethical behavior and has primary responsibility for developing, directing, and leading compliance with federal, state, and local laws, rules, and regulations. The position manages assigned compliance staff; chairs various compliance committees; is responsible for implementing, coordinating, and providing day-to-day management and oversight of the company’s fraud, waste, and abuse programs and privacy programs; and providing guidance and reporting to senior management and the Board.

Major Work Activities

Develops, implements maintains, and coordinates the compliance program and compliance plan, ensuring all necessary elements are addressed to ensure compliance with federal and state legal and regulatory requirements
Provides guidance and reporting to senior leadership and the board of directors
Chairs the Corporate Compliance and Integrity Committee
Serves as the point of contact with the Centers of Medicare & Medicaid Services and the state department of insurance and other areas
Develops policies, procedures, and processes to comply with federal and state program regulations
Ensures the maintenance of necessary compliance reporting mechanisms and documentation to meet federal and state contractual and regulatory requirements
Oversees regulatory reporting, ensuring timeliness and review of trends
Reviews of vendor compliance/reporting including pre-delegation reviews
Investigates potential non-compliance with the Compliance Plan, Code of Conduct, conflicts of interest or FWA received from any source
Coordinates with all functions and leadership and, as required, the Director of human resources to oversee and assists managers to create corrective action plans to identify compliance issues or concerns as required, monitors and ensures corrective action plans are implemented
Coordinates with all Medicare functions (i.e., Operations, Sales/Marketing, Appeals and Grievances, Claims, Care Management, etc.) to ensure each area understands federal and state requirements and works with the areas to meet all government agency compliance and reporting requirements
Identify, evaluate, and analyze the impact of CMS and Medicare regulatory issues and advise management concerning the impact
Oversees the identification, implementation, and maintenance of the privacy program in compliance with state and federal laws
Establishes and maintains a mechanism to track access to protected health information and responses to potential disclosures or breaches
Collaborates with all areas to identify and manage risks
Conduct annual risk assessments and develop a monitoring audit plan (both pre-delegation as well as internal/external audits)
Conduct audits of operational areas compliance and develop and implement corrective action plans
Coordinate all external audits, reviews, and monitoring of the company
Manage and supervise assigned staff and intercompany support relationships to accomplish the goals of the Company
Other duties as assigned



Requirements
Requirements

Minimum Qualifications

Required Education

Bachelor’s Degree or seven (7) plus years of related experience

Required Licensure/Certification

Annual Flu Vaccine

COVID-19 Vaccine

Required Experience

At least seven (7) years of experience in Managed managed Care care compliance and operations.
At least seven (7) plus years’ in Medicare Advantage regulatory compliance.
Demonstrated experience conducting risk assessments and monitoring audits.
Demonstrated organization, facilitation, communication, analytical, and presentation skills.
Proficient in Word, Excel, and PowerPoint.
Required Knowledge, Skills, and Abilities

Excellent written and verbal communication in one-on-one settings in public
Highly effective at building rapport, credibility, and trust across multiple audiences
Strong leadership practices that include monitoring performance and coaching
Analytical and organizational skills
Strong decision-making and problem-solving skills
Ability to foster relationships internal and external to the company
Executive skill set and emotional intelligence
Proficient in business software (e.g., MS Office products)
Preferred Education

Master’s Degree or Juris Doctorate

Preferred Licensure/Certification

Certified in Healthcare

Compliance (CHC)® or equivalent certification

Preferred Experience, Knowledge, Skills, and Abilities

Experienced working directly with the Centers for Medicare & Medicaid Services.
Experience working directly with the State Department of Insurance.
Experience conducting internal audits.

Time:  Full time
Salary:  Salary
Category:  Compliance

Updated: 6/14/2022 9:57:25 AM