The employer operates within the insurance sector.
- Perform management responsibilities including, but not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
- Oversee the Medicaid Government Compliance team and for the implementation of the Medicaid Compliance program. This leadership role makes sure the business is properly following the growing number of laws, regulations and other requirements set forth by the government (both State and Federal). Must be able to lead the further development, implementation, and maintenance of an effective government compliance and risk management program.
- Direct business owners and management across the organization on all aspects of regulatory requirements. Specifically subject matter expert in knowledge and comprehension of requirements, organizational support related to understanding of requirements, coordinate ongoing monitoring of any new applicable requirements, manage centralized reporting of new requirements, and oversee remediation of any identified risks related to regulatory requirements.
- Manage complex regulatory projects to monitor ongoing compliance with existing requirements, as well as addressing any changes, corrections, clarifications, or new requirements, by: developing and implementing work plans, obtaining status updates, reviewing outcomes, recommending changes (as needed), and working with the applicable business owner on finalization.
- Report to the Board of Directors and other Board-level/ownership level organizations on the activities of the Medicaid Government Compliance team, preparing routine and ad-hoc reports on departmental activities, investigations, audits, and risk assessments. In role of Medicaid Compliance Officer, routinely interface with external State and Federal agencies.
- Lead all State and Federal Audit Activities. As the organization enters new States, this includes identifying new state requirements and developing associated Medicaid Compliance Plans, planning and hiring for appropriate staff as may be required and implementing and monitoring programs.
- Other duties as assigned.
- Bachelor's Degree in Accounting or Finance
- 7 - 10 years working in the Health Insurance Industry. Or
- 7 - 10 years in Compliance
- 5 - 7 years in Management
- 3 - 5 years in Project Management
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