Vice President, Compliance
Our Client is a respected and financially strong
insurance carrier with a national presence. You would have an opportunity to be
part of the expansion of this division if you were selected to join the leadership
team. Making a difference in healthcare is what we they do, are you ready
to be part of something unique?
The Vice President,
Compliance, functions independently to provide oversight and guidance to the
Board and senior management team regarding risk management, regulatory
guidance, and policies and procedures to protect and grow the Company's
business interests of Medicare Advantage.
Contributes to the
overall Medicare Advantage strategy, provides guidance and recommendations to
internal and external business partners to develop, maintain and enhance
Medicare Advantage programs, products and service.
You will oversee and direct regulatory and compliance functions for
health plan operational areas, serves as liaison with regulatory authorities
(Centers for Medicare and Medicaid Services (CMS) and State Insurance Depts.)
relative to Medicare compliance program activities.
You will be responsible for the development and implementation of the
Medicare compliance program structure, compliance education/training, auditing
and monitoring program, reporting and compliance mechanisms.
Responsible for response and correction procedures for compliance
issues and compliance expectations for all personnel and first tier, downstream
and related (FDR) entities that support core functions of contracts with
You review and interpret proposed and ongoing regulations, and ensures
effective compliance activities, policies and practices.
You will evaluate compliance with Medicare regulations applicable to
Company operations and consults with Senior Leadership regarding deviations and
solutions to ensure corporate compliance.
Implements and directs the audit, monitoring, verification and
mitigation of compliance risks associated with Medicare Advantage. Oversees
various audits conducted internally and externally, particularly CMS audits.
Ensures that risk assessments with Medicare Advantage are conducted in
accordance with CMS audit guidelines and other applicable regulatory bodies.
Plans and executes CMS audit readiness and assessment of program effectiveness.
You will prepare reports and submit results to Senior Leadership and
Board of Directors for review, follow-up, and recommendations for action.
This includes overseeing and directing Medicare Advantage Fraud, Waste
and Abuse (FWA) program to ensure compliance with Medicare and other state
You develop and oversees a process for uniform handling of Medicare
Advantage compliance matters. Collaborates with other departments to direct
compliance issues to appropriate existing channels for investigation and
Oversees Medicare Advantage vendors, third parties and consultants to
ensure delegated activities are compliant with Medicare and other regulatory
requirements with respect to compliance.
Maintains education, awareness, and knowledge of current Medicare
regulations, best practices within the industry and the management of health
plan operations. Brings regulatory changes and matters of significance or
urgency to the attention of Senior Leadership and facilitates necessary changes
for compliance to improve business practices.
You serve as a resource for internal business partners by continuously
maximizing knowledge and expertise related to Medicare products.
BA/BS with commensurate Compliance industry experience.
10+ years' experience in a Medicare or healthcare Compliance leadership
Seasoned knowledge and experience within the insurance and financial
service industries related to compliance, governance, regulatory, legal
Seasoned knowledge and understanding of healthcare laws, regulations,
and standards, specifically related to Medicare and Medicare Advantage
Thorough understanding of health plan operations, finance, quality,
coding and reimbursement systems, risk management, fraud, waste and abuse
programs, human resources, and performance metrics.
Experienced in interpretation, implementation and management of HIPAA Privacy
and Security Rules.
Extensive knowledge of emerging compliance trends and the ability to
identify and assess compliance risks and develop corporate strategies.