Compliance Program Manager III

Compliance Program Manager III

Under the direction of the Director or Senior Manager of the department, the Compliance Program Manager III manages compliance programs, regulatory projects and initiatives with significant complexity, risk and/or regulatory scope. Initial key responsibilities will include medium to large scale projects and initiatives, including management of compliance focused regulatory audits. Responsibilities include successful implementation of large cross-functional compliance initiatives and management of a compliance function that helps identify and mitigate risks of noncompliance with complex regulatory requirements and guidance.

These responsibilities require strong negotiation and risk management skills as well as sharp analytical skills. By using knowledge of the company, the Compliance Program Manager III should be able to resolve most roadblocks to ensure success and progress. The Compliance Program Manager III 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 to explain and assess the impact. The Program Manager III 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.

The Program Manager III is responsible for:

• Management of cross-functional compliance projects and initiatives
• Proactive and solutions-oriented management of compliance initiatives and integration issues, requiring the ability to conceptualize and envision the impact of regulatory and business changes to the internal compliance readiness, and propose ways to meet regulatory obligations by understanding business functions and needs.
• Management of regulatory audits to ensure alignment in approach across compliance departments and with the rest of the organization.
• Evaluating and analyzing regulations and sub-regulatory guidance, interpreting their significance, and recommending policies to ensure compliance.
• As directed, support risk assessments using data analytics and regulatory insights
• Leading and/or managing projects and initiatives by representing regulatory and compliance expectations and requirements during the planning and implementation phases. This includes coordinating issue resolution with relevant business areas and facilitating planning and review sessions.
• Providing support in the overall management of 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.
• Support the strategic priorities of the organization and compliance program through annual planning, enhancing compliance functions, and driving future needs to support ongoing compliance development activities.
• Support the development of monthly and/or quarterly compliance reporting as required by management and organizational Committees.
• Understand regulatory requirement and industry, to help drive a successful compliance program through prevention, detection, and correction of potential issues of noncompliance and/or fraud.

Certification and Licensure

Education

• Required (minimum):
  Bachelor's Degree or equivalent work experience
• Preferred:

Experience

• Required (minimum): 5-8 years of regulatory, compliance and legislative activities, health insurance operations or legal research or equivalent combination of education and experience . 3+ years of Medicare, Medicaid and/or commercial compliance experience.
• Preferred:

Skill Requirements

• Excellent verbal and written communication skills generally acquired through college or other advanced education is required, ability to facilitate planning and…