Lead Compliance Program Manager

About the role

The Lead Compliance Program Manager will be responsible for development, implementation and management of significant and complex compliance programs, initiatives and projects associated with federal and state regulations for applicable lines of business (Corporate, Commercial, Medicare, Duals and/or Medicaid).

Responsibilities

• Provide support in overall management of the compliance program key functions, including developing compliance workplans across all elements of an effective compliance program, including (but not limited to): Risk Assessment; Monitoring and Auditing; Effective Communication; Training and Education; Policies and Procedures; Vendor Oversight; Issue correction and remediation.
• Ensure ongoing compliance with established, revised, or new regulatory requirements that impact the organization, including delivery of benefits for members.
• Oversee the compliance program through employee and leadership communications, coordination of policy development and ensure accurate and timely communication to all departments.
• As applicable, conduct risk assessments, focused reviews, and/or audits to identify potential compliance issues and vulnerabilities.
• Effectively identify regulatory and compliance risks and provide plan of remediation.
• Manage significant or complex regulatory audits to ensure timely completion of data and documentation collection, review, and submission. Perform review of regulatory audits results. Support development of responses. Track monitoring of responses and remediation actions.
• Lead and/or manage projects and/or initiatives by representing regulatory and compliance expectations and requirements during planning and implementation phases. This may include coordinating issue resolution with relevant functional business areas, and leading and/or facilitating planning and review sessions.
• Evaluate and analyze regulations and sub-regulatory guidance, interpret their significance and recommend and review policies to ensure compliance.
• Manage tracking, investigation, and resolution of compliance oversight activities such as issue management, monitoring and auditing. Lead and coordinate responses to compliance violations and incidents.
• Prepare monthly and/or quarterly compliance reporting for the organization’s leadership and organizational Committees.
• Understand regulatory requirements and industry to help drive a successful compliance program through prevention, detection, and correction of potential issues of noncompliance and/or fraud.

Qualifications

• Bachelor's degree: in business, law, compliance, or a related field preferred.
• Advanced degrees and relevant certifications are a plus.
• Experience (minimum Years Required): 8 or more years of regulatory, compliance and legislative activities, health insurance operations or legal research or equivalent combination of education and experience.
• 3 – 5 years of Medicare, Medicaid and/or Commercial compliance experience.
• Demonstrated knowledge of government regulations as they relate to the administration of Medicare and/or Medicaid healthcare programs, principles, and practices of managed care.

Skills

• Excellent verbal and written communication skills generally acquired through college or other advanced education is required, ability to facilitate planning and review sessions.
• High level presentation skills including ability to interface effectively with internal and external contacts and present technical information in a way that establishes rapport and gains understanding.
• Ability to exercise sound judgment and raise issues and potential solutions to appropriate team members or management for resolution;
• Strong analytical skills to develop new or implement change to existing program functions.
• Ability to interpret and explain the implications of planned changes to current state business units.
• Ability to problem solve and overcome obstacles to ensure successful program operations.

Technical Skills

• Proficiency with MicroSoft Office applications (Word, Excel, PowerPoint).
• Ability to utilize multiple applications simultaneously.

Interpersonal Skills

• Requires the ability to work cooperatively as part of a team.
• Must be able to effectively communicate with all internal departments in verbal and written formats.
• Must be able to work in a matrix environment with minimal supervision.
• May need to coordinate the participation of other internal contacts to develop and or maintain programs.
• Able to navigate issues using advanced organizational knowledge.
• Is an effective, strong advocate for the program and negotiates/leads others both internally and externally to participate to ensure success in the program.
• May be required to coach/mentor less experienced staff and effectively lead in a matrixed environment.
• Proactively identifies conflict/integration issues and leads team members to parse/synthesize issues of the highest complexity.
• Able to identify risk out of the larger picture and develop risk analysis for consideration.
• Advanced content knowledge of the specific program.