Job Description:

We enjoy the important work we do every day on behalf of our members.

Job Summary

The purpose of the position is to provide leadership and direction of Point32Health Government Programs Compliance Program across all lines of business. This includes identifying and having a detailed knowledge of compliance requirements; identifying compliance risks; and direct administration of activities, projects and personnel necessary to ensure compliance with Medicare and Medicaid laws and regulations governing contracts with the Centers for Medicare and Medicaid Services (CMS). Officially manages the interface with the Centers for Medicare and Medicaid Services for all compliance program matters. Leads the enterprise risk identification and risk mitigation efforts for government programs compliance.

The Government Programs Compliance Officer will report to the Chief Compliance Officer and will be responsible for coordinating external audits and internal self-monitoring reviews and reporting findings to the Compliance Steering Committee and the Board of Directors Audit and Compliance Committee. This includes supporting the Chief Compliance Officer and working collaboratively as a member of the compliance leadership team.

Job Description

Provide leadership for execution on a strategy for a sustainable Medicare Compliance Program that is effective and efficient. This includes leading people and processes and building a culture of integrity.

Manage, document and maintain a coordinated regulatory Government Programs Compliance Program that meets the expectations of State and Federal regulators and corporate governance programs.

Ensure a high-standing relationship with CMS regulators in support of Point32Health's products and meet the expectations and requirements of internal and external customers. Serve as primary liaison between CMS and Point32Health to respond to CMS concerns and to advance Point32Health's business and regulatory priorities.

Provide oversight and leadership for internal monitoring activities.

Develop and implement program policies, procedures and practices designed to promote compliance with the requirements of State and Federal health care programs. Also develop and implement policies and procedures that implement components of the compliance program.

Work with business unit leaders to increase awareness of the importance of the Compliance Program and develop and maintain positive relationships between compliance and operations personnel. Attend operations staff meetings for functions with significant impact on Medicare and Medicaid Compliance.

Work with business unit leaders to provide adequate information to ensure that they and their employees have the requisite information and knowledge of regulatory issues and requirements to carry out their responsibilities in a lawful and ethical manner.

Manage the compliance unit's administrative duties. This includes organizing and maintaining relevant documents; preparing necessary reports on activities; and supervising support staff, as needed.

Monitor Compliance performance by operational areas.

Undertake investigations of Compliance inquiries, prepare reports and monitor remediation.

Develop external contacts to position the Company as a leader in health care compliance programs.

Implement and maintain Medicare, Medicaid and FDR risk assessment process coordinated with organizational broader risk assessment process.

Develop and maintain program and procedures for First Tier Downstream Related entities oversight.

oversee Government Programs audit and monitoring plan.

Monitor and report on the effectiveness of corrective action plans.

Collaborate with the Fraud special investigations unit to ensure program meets CMS requirements.

Positon compliance as a strategic partner that mitigates risk and adds value to organizational performance.

Requirements

EDUCATION: (Minimum educations & certifications required)

JD or Masters Degree in health care administration, public service administration or related field.

EXPERIENCE: (Years of experience)

Minimum of 10 years' experience ( 3-5 years of Medicare and Medicaid Compliance experience) in personnel management and compliance related activities, legislative and regulatory activities, health insurance operations or legal research or equivalent combination of education and experience. Minimum of five years in a executive leadership role.

Strong experience with Medicare and Medicaid health care products is required. Demonstrated knowledge of government regulations as they relate to the administration of Medicare healthcare programs, principles and practices of managed care. 3-5 years experience in a leadership role.

SKILL REQUIREMENTS: (Include interpersonal skills)

• Strong research, writing, public speaking and computer skills


• Understanding of health policy issues related to medical and other healthcare activities.


• Strong subject matter expertise in Medicare Operations and Compliance Requirements


• Demonstrated effectiveness operating in complex organizational environments.


• Clear, concise and persuasive writing, communication and presentation skills.


• Proven ability to work with all levels of management.


• Strong leadership skills with the ability to lead across the enterprise.


• Ability to be decisive and exercise sound judgment under pressure.


• Ability to problem solve in a collaborative manner with business partners.


• Strong problem solving skills.


• Ability to manage a diverse and demanding workload.


• Strong planning, organizational and change management skills


• Interpersonal skills including the ability to listen accurately and responsively, delegate responsibilities as appropriate and facilitate relationships.


• Demonstrated ability to create a long term vision and manage a team and function to that vision.


• Decisive and exercise good judgment under pressure.


• Demonstrated ability to partner effectively with others in the handling complex issues


• Strong leadership skills with ability to lead cross functional teams


• Ability to develop and support staffin their professional development


• Sense of Humor

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel,) CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Point32Health is considered confidential. Will be exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy and department guidelines/policies and all applicable laws and regulations at all times.

What we build together changes our customer's health for the better. We are looking for talented and innovative people to join our team. Come join us!

As of Nov. 1, 2021, full vaccination against COVID-19 is required to enter any Point32Health office or if, on behalf of Point32Health, you are meeting in-person with individuals outside of a Point32Health office. As of Dec. 8, 2021, all employees - including remote employees - must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law.

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