Director, Compliance (Contract Administrator)

Position Overview

Become a part of our caring community and help us put health first. The Director, Compliance ensures compliance with governmental requirements. This role requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

Responsibilities

• Report directly to the State Market Leader for Medicaid (Ohio CEO) and board of directors on all compliance issues.
• Manage the connection of MCO personnel to the Ohio Department of Medicaid business owners.
• Develop and implement written policies, procedures, and standards to ensure compliance with requirements set forth in the Contract.
• Identify and analyze potential sources of loss to minimize risk.
• Serve as the primary point of contact for all MCO compliance issues.
• Coordinate the tracking and submission of all contract deliverables, including fielding and coordinating responses to ODM inquiries.
• Coordinate, prepare for, and facilitate random and periodic audits and site visits.
• Assess and communicate information regarding business risks with functions across the organization.
• Represent the organization in Internal Compliance committees and manage LRRs.
• Coordinate the preparation and execution of Contract documents, audits, and ad-hoc visits.
• Advise executives to develop functional strategies on matters of significance.
• Use independent judgment requiring analysis of variable factors and determine the best course of action.
• Participate in required Compliance meetings with the Ohio Department of Medicaid.
• Monitor all functional areas for compliance with the Medicaid contract and follow up for corrections of deficiencies.
• Direct implementation of plan projects, state contract initiatives, executive-sponsored initiatives, and risk assessments.
• Lead compliance monitoring to identify process gaps, validate compliance levels, map processes, oversee implementation of corrective actions, and prepare reports/presentations.
• Develop strategic plans, make recommendations to leadership, and assess and communicate information regarding business risks with functions across the organization.
• Oversee development, execution, and compliance with the Business Continuity Plan and associated state reporting.
• Develop strong relationships with external state partners and internal leaders to identify and address compliance risks and failures.
• Ensure the preparation and execution of state ad hoc requests aligns to requirements.
• Ensure program compliance with federal, state, and contractual requirements; collaborate with appropriate business areas to develop policies, procedures, and systems to secure and demonstrate compliance with all mandates.
• Research potential compliance issues and recommend changes that assure compliance with contract obligations.
• Develop and implement compliance policies and procedures.
• Ensure the tracking and timely submission of all Contract deliverables.
• Maintain relationships with ODM and other relevant government agency contacts.
• Participate in Ohio program integrity and Medicaid compliance forums and programs.
• Oversee resolution of ODM Contract compliance issues, including corrective action plans.
• Field and coordinate responses to ODM inquiries.
• Monitor and understand emerging Medicaid policy; provide recommendations and direction in the implementation of new initiatives to be compliant with emerging policy.
• Use your skills to make an impact.

Requirements

• Bachelor’s Degree
• Must reside in Ohio
• 8 or more years of experience in operations or compliance-related field
• 5 or more years of management experience
• Experience working with regulatory agencies, including state departments of health insurance or CMS
• Extensive knowledge and experience

Employment Type

Full time

Location Type

Information not provided

Salary

Information not provided