Enterprise Regulatory Compliance Audit & Monitoring Program Admin I​/II​/III

Job Summary

This role performs audits to ensure the organization is in compliance with federal, state and Association regulatory requirements (Centers for Medicare and Medicaid Services, Department of Health, Department of Financial Services, Department of Labor, Blue Cross Blue Shield Association, Federal Employee Plan, Office of Inspector General, Office of Medicaid Inspector General). The Administrator provides collaborative oversight and management of regulatory requirements to achieve optimal compliance performance to meet corporate goals.

The incumbent will support risk mitigation by assessing regulatory compliance through various methods including auditing and monitoring, conducting root-cause analysis, identifying best practice opportunities, and making recommendations for process improvement or refinement activities.

• Researches, interprets, and communicates regulatory requirements to internal customers. Prepares business areas and all levels of personnel for upcoming external audits, including but not limited to reference materials, audit basics, expectations, coordinating and facilitating education sessions, etc.
• Assesses potential non-compliance vulnerabilities and identifies root causes of issues. Collaborates with business area ambassadors to develop recommendations and reach meaningful and appropriate resolutions.
• Independently facilitates, establishes, manages, and monitors work teams to successfully conduct internal and external audits and surveys. Plans, performs fieldwork, reports and follows up on specific audit assignments.
• Facilitates and provides guidance on corrective action responses to examination findings and collaborates with Compliance to ensure appropriate processes and controls are documented to address risks and deficiencies.
• Acts as the single point of contact for State and Federal examiners to ensure any questions are addressed and the requirements are understood by all stakeholders.
• Develops and manages risk assessments including data collection, integrity testing, and routine reporting across the corporation.
• Develops, maintains, and analyzes various reporting sources including those related to regulatory commitments, Ad Hoc Corporate issues and all general Regulatory compliance issues.
• Initiates and executes long and short-range planning processes and identifies and schedules resources required to meet audit plans, deliverables, and objectives.
• Effectively leads and manages assigned Regulatory Compliance initiatives and projects.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

• Acts as a cross-functional resource to operational areas regarding regulatory compliance matters.
• Performs audits across multiple lines of business.
• May oversee audits performed by external vendors and regulatory agencies.
• Serves as a mentor and shares acquired knowledge and expertise to help others learn and grow.

• Manages the highest level of complex regulatory compliance issues and exercises decision-making in cross-functional work groups.
• Facilitates audits conducted by regulatory agencies.
• Provides guidance to less experienced team members and internal customers in the absence of management. Acts as a resource for the department and serves as a trusted advisor to the organization.

• Nine or more years' experience in health insurance or health care delivery, or Bachelor's degree in related area with five or more years of related experience or compliance training.
• Extensive knowledge of regulatory initiatives and legislation that impacts the Health Insurance Industry.
• Demonstrated ability to understand regulations and administer compliance for all areas across an organization.
• Strong analytical and organizational skills and ability to manage multiple projects and systems simultaneously with minimal management directive. Ability to effect change efficiently and smoothly.
• Demonstrated experience in taking ownership of issues and follow through to resolve them promptly and accurately.
• Exceptional verbal and written communication skills and ability to collaborate across the organization.

• Nine or more years in health insurance or health care delivery or Bachelor's degree in related area with seven or more years of related experience or training.
• Progression toward Certified Internal Auditor (CIA) certification desirable.
• Ability to independently perform regulatory audits across multiple lines of business.