Role and Responsibility:
•Assist the organization in achieving responsible and effective corporate (risk management) and compliance programs •Formulates an organization-wide integrated and holistic approach to governance, risk and compliance including strategy, processes, technology and people •Proactively identify major risk events •Perform risk assessments and compliance investigations •Coordinates Ethics & Compliance hotline •Monitors key compliance risk areas and may engage outside services for compliance audits •Ensure that improvement opportunities and problems identified through auditing and monitoring have been addressed through effective follow up mechanisms including management accountability and remedial action •Maintain current knowledge of laws and regulations •Establish policies and procedures to maintain compliance •Educate on compliance program, policies & procedures and communicate awareness •Monitor compliance with laws, regulations, policies and procedures •Responds to all concerns reported to compliance functions and hotline •Recruit and develop key staff •Serves as Chair, Compliance Committee and Vice Chair, ERM Committee •Serves as HIPAA Privacy Officer •Ensure effective staff compliance training program •Responsible for CIA, IRO, OIG, investigations hotline and training (including 7 elements)
•Bachelor of science degree in business administration, healthcare administration or related discipline is or equivalent work experience is required •Master’s in Business Administration, Healthcare Administration and/or other related discipline is preferred •Seven or more years of experience in a compliance leadership role is required •Senior Executive Leadership experience with a managed care organization or related industry
•Strong working knowledge of compliance theory, practices, laws, regulations, guidelines and professional standards •Depth in governmental product design and experience working with underserved populations •Understanding of Medicare/Medicaid regulatory requirements •Strong understanding of healthcare finances •Knowledgeable of HCCA, AHIA, COSO •Commitment to the mission and values of the CareSource Family of Companies •Strong collaborative skills, working with cross-functional stakeholders and external partners including state and federal regulators •Effective communication and presentation skills
•Certified in Health Care Compliance (CHC) is preferred
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