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Compliance Director

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This is a Full-time position in Tallahassee, FL posted April 7, 2021.

Director, Compliance – Managed Care

The Director, Compliance – Managed Care will evaluate, develop, and implement Compliance programs for Managed Care Quality. Maintain the visibility of Compliance programs throughout the Organization. Monitors, recommends, trains, and implements compliance initiatives throughout the organization. Ensures that the Company complies with Federal, State and Local laws, State Medicaid Programs, and healthcare organizations’ information privacy practices. Manages all State and Federal licensing.

GENERAL DUTIES & RESPONSIBILITIES:

  • Demonstrated strong knowledge of healthcare compliance laws and regulations (e.g., HIPAA, Medicare, Medicaid, Anti-Kickback, Fraud and Abuse laws, False Claims Act) in order to develop and lead an effective Compliance Program.
  • Develop annual and quarterly compliance risk assessments and compliance reviews.
  • Examine and review departmental policies, procedures, and practices to ensure compliance with Medicaid/Medicare laws, regulations, and accreditation standards.
  • Lead the development and implementation of compliance policies and procedures within the scope of existing state/federal Medicaid/Medicare requirements.
  • Assess, improve and streamline existing compliance programs.
  • Lead in the development of new compliance programs.
  • Develop compliance auditing and monitoring plans.
  • Work with various departments in establishing coding audits.
  • Develop and deliver compliance training programs and communications.
  • Lead auditing and monitoring projects to address specific healthcare compliance risks.
  • Develop compliance analysis and reporting.
  • Demonstrate high levels of communication from all level of internal and external audiences.
  • Develops reporting packages to communicate changes to applicable internal and external stakeholders.
  • Identifies potentially material fee schedule, regulatory and statutory changes and escalates the impact to a team product, operational and financial personnel to develop applicable action plans to address the potential material impacts.
  • Assists Government Relations in development of strategies to lobby and attempt to proactively impact regulatory and statutory changes.
  • Deploys and manages the implementation program for the enterprise compliance function including the deployment and management of processes to respond to any regulatory and statutory change.
  • Interfaces with legal counsel and federal, state, and local agencies, as needed to address regulatory or compliance issues, concerns or questions.
  • Assists the business with responses to customer compliance-specific questions and concerns.
  • Participates with and/or leads customer focus and advisory groups.
  • Performs other related duties as assigned.
  • If working with federal government contract clients, an employee is required to receive federal government clearance for handling sensitive information. Employee is also required to receive annual security awareness training.

 EDUCATIONAL & EXPERIENCE REQUIREMENTS:

  • Bachelor’s degree required with 8 or more years of relevant work experience in business administration or political science, law or the equivalent combination of education, training, and work experience. Advanced degree preferred. HC (Certified in Healthcare Compliance), CHPC (Certified in Healthcare Privacy Compliance) or CCEP (Certified Compliance and Ethics Professional) preferred.

 GENERAL KNOWLEDGE, SKILLS & ABILITIES:

  • Occasional travel required to the Headquarters office in Jacksonville, Florida.  10-15% expected.
  • Demonstrated ability to supervise and lead a small team.
  • Communicates ideas both verbally and in written form in a clear, concise, and professional manner.
  • Extensive knowledge of Medicare, Medicaid, Anti-Kickback, Fraud and Abuse laws, False Claims Act, privacy laws.
  • Outstanding communication skills with both internal and external clients and customers.
  • Strong analytical skills.
  • Ability to understand technical documents and legal or regulatory reference materials.
  • Ability to understand and apply learned concepts.
  • Demonstrated ability to plan and complete work within tight time limitations.
  • Ability to apply creative problem-solving techniques and tools to compliance issues.
  • Ability to follow and conduct a compliance monitoring program.
  • Ability to provide information to a variety of audiences and deal effectively with confidential issues that are sensitive in nature.
  • Ability to share information with awareness of its effect on others.

EEO Employer