Director Health Plan Compliance Officer Job

Job Title:
Director Health Plan Compliance Officer
Job ID:
10345
Location: Virginia Beach, VA

Full/Part Time:
Full-Time
Regular/Temporary:
Regular

JOB SUMMARY:
The Compliance Officer (CO) is responsible for implementing the Corporate Compliance Program (CCP) at the health plan level that serves to prevent and detect crime, to promote compliance with corporate policies and upholds an ethical culture. Additionally, the individual in this role will be responsible for developing and implementing specifically-tailored compliance education sessions to address key issues; and for designing and implementing a compliance communication strategy to keep senior management and other relevant associates informed of changes to the regulatory environment within the scope of the CCP, as well as communicating about specific compliance program initiatives throughout the year.

PRIMARY RESPONSIBILITIES:

1. Establish scope of activities required to support the Compliance Effectiveness Review at the Plan Compliance Officer (PCO) level:

· Lead and assure compliance training activities are completed in an effective manner
· Monitor health Plan Performance Standards for compliance with contractual and regulatory requirements and maintain a general focus on call center metrics, claims payments, minimum net worth and licensure of health plans and employed professional
· Maintain relevant Plan Policies and Procedures that may impact the Plan or Company and provide assessments to critical stakeholders and Plan senior leadership on consistency with regulatory and contractual requirements including anti-kickback statutes, timeliness of enrollment; and incentive compensation
· Review policies and procedures and health plan activities to ensure adherence to Business Associate requirements and physical and electronic security under HIPAA
· Ensure regular meetings of the Plan Compliance Committee (PCC) to discuss identification and assessment of compliance initiatives, potential risks and current state
· Serve as liaison to external and internal audits between business owner and state/federal entities
· Coordinate with OBE on preliminary investigations of potential non-compliance; maintain confidentiality as appropriate and recommend corrective action or next steps to OBE and business owners
· Monitor payments or contributions to providers and community and faith based organizations made by or on behalf of the health plan to ensure compliance with AGP's policies and procedures including but not limited to charitable donations and gifts
· Maintain a quarterly log of marketing materials reviewed via CMAP, submitted to the governing agency and approved for use and perform monthly reviews of marketing field activities to ensure compliance
· Monitor and evaluate member access through review of changes in network composition and appointment guideline surveys
· Verify control process used to ensure accuracy of information submitted to government agencies;
· Establish schedule to monitor corrective actions related to issues identified at the PCC level
· Attend and participate in meetings where business strategy is discussed with Plan senior leadership.
· Provide regular and ad hoc reports on activities outlined above for review by the OBE and health plan CEO/EVP
· Other Duties as assigned

EDUCATION AND EXPERIENCE:
Education:
Required: Bachelors degree from an accredited university
Preferred: Masters or higher degree in Law, Business, Healthcare

Years and Type of Experience Required::
Required: Minimum of 7 years relevant experience in healthcare compliance, audit or compliance, with at least 3 years of leadership/management experience.
Preferred: Experience in conducting or responding to government audits and investigations, and/or direct experience working in a relevant federal agency(HHS, OIG, CMS)

Specific Technical Skills:
Required: Proficient in the use of MS Office (Visio, Excel, Access, Word)
Preferred:

Certifications or Licensure:
Required:
Preferred: CHC, Current license to practice law in at least one state, CPA or CIA

Other:
Required:
· Excellent verbal and written communication skills; Solid analytical skills and knowledge of controls
· Strong leadership skills with the ability to influence and manage.
Preferred:

SCOPE INFORMATION

Item Measure
· # Direct Reports 0
· # Indirect Reports 0-5
· Budgetary $ Responsibility
· Areas of Responsibility

PHYSICAL REQUIREMENTS
· Must be able to operate a computer and telephone.
· Travel 30% on common carriers and adhere to AMERIGROUP travel policies.

Equal Employment Opportunity

In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

Nearest Major Market: Virginia Beach
Job Segments: Compliance, Healthcare, Legal, Management, Manager, Medical