Lead Compliance Program Manager

Lead Compliance Program Manager

The Lead Compliance Program Manager will be responsible for development, implementation and management of significant and complex compliance programs, initiatives and projects associated with federal and state regulations for applicable lines of business (Corporate, Commercial, Medicare, Duals and/or Medicaid). This work requires partnering with internal departments as well as external stakeholders including government regulators and auditors. The Lead Compliance Program Manager will be responsible for collaborating with leadership, teams and partnering departments to define and execute strategic compliance initiatives in order to accomplish successful compliance oversight and maintain an effective compliance program.

The Lead Compliance Program Manager should make recommendations for change by performing risk analysis and by using basic analytical and problem-solving capabilities to support the recommendation. Responsibilities at this level usually require facilitating cross-departmental meetings and negotiations with outside parties and regulators to explain and assess the impact. The Lead Compliance Program Manager will also interact directly and regularly with leadership within the department and within Point
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Health to accomplish successful compliance oversight and maintain an effective compliance program.

Key Responsibilities/Duties – what you will be doing (top five):

• Provide support in overall management of the compliance program key functions, including developing compliance workplans across all elements of an effective compliance program, including (but not limited to):
  Risk Assessment;
  Monitoring and Auditing;
  Effective Communication;
  Training and Education;
  Policies and Procedures;
  Vendor Oversight;
  Issue correction and remediation.
• Ensure ongoing compliance with established, revised, or new regulatory requirements that impact the organization, including delivery of benefits for members.
• Oversee the compliance program through employee and leadership communications, coordination of policy development and ensure accurate and timely communication to all departments.
• As applicable, conduct risk assessments, focused reviews, and/or audits to identify potential compliance issues and vulnerabilities. Effectively identify regulatory and compliance risks and provide plan of remediation.
• Management of significant or complex regulatory audits to ensure timely completion of data and documentation collection, review, and submission. Perform review of regulatory audits results. Support development of responses. Track monitoring of responses and remediation actions.

Qualifications – what you need to perform the job

Education, Certification and Licensure

• Bachelor's degree: in business, law, compliance, or a related field preferred.
• Advanced degrees and relevant certifications are a plus.

Experience (minimum years required):

• 8 or more years of regulatory, compliance and legislative activities, health insurance operations or legal research or equivalent combination of education and experience. 3 – 5 years of Medicare, Medicaid and/or Commercial compliance experience. Demonstrated knowledge of government regulations as they relate to the administration of Medicare and/or Medicaid healthcare programs, principles, and practices of managed care.

Skill Requirements

• Excellent verbal and written communication skills generally acquired through college or other advanced education is required, ability to facilitate planning and review sessions.
• High level presentation skills including ability to interface effectively with internal and external contacts and present technical information in a way that establishes rapport and gains understanding.
• Ability to exercise sound judgment and raise issues and potential solutions to appropriate team members or management for resolution;
• Ability to conceptualize the impact of change and propose new methods of conducting business
• Strong analytical skills to develop new or implement change to existing program functions
• Ability to interpret and explain the implications of planned changes to current state business units
• Ability to problem solve and overcome obstacles to ensure successful program operations

Technical skills:

• Proficiency with Micro Soft Office applications (Word, Excel, PowerPoint)
• Ability to utilize multiple applications simultaneously

Interpersonal skills

• Requires the ability to work cooperatively as part of a team.
• Must be able to effectively communicate with all internal departments in verbal and written formats.
• Must be able to work in a matrix environment with minimal supervision
• Using knowledge of the company, able to resolve most roadblocks to program progress. Ability to operate and thrive in a matrixed-management, hands-on environment that demands a consultative approach and solutions environment with minimal supervision. May need to coordinate the participation of other internal contacts to develop and or maintain programs.
• Able to navigate issues using…