Manager, Compliance

Responsibilities

• Performs to required standards for job specific responsibilities and technical competencies.
• Develop and implement policies, procedures, and practices designed to ensure compliance with the Office of Inspector General guidance, ACA program requirements, and other applicable laws and regulations.
• Support organization’s compliance program in accordance with all applicable laws and regulations.
• Maintain compliance with state and federal requirements applicable to benefit plans offered by the University of Utah Health Insurance Plans.
• Support the health plan’s Compliance program with a particular focus on Qualified Health Plan (QHP) compliance requirements.
• Monitor the day-to-day compliance activities including implementing a monitoring and auditing plan.
• Work closely with all departments for effective investigation, resolution, reporting, and remediation of compliance issues.
• Develop and conduct compliance risk assessments.
• Minimizes legal and compliance risk by monitoring, analyzing, and communicating current and proposed state and federal legislation, regulation, and sub-regulatory guidance.
• Acts as a subject matter expert, answers questions, provides guidance and oversight for resolution of compliance issues that arise in the business.
• Act as compliance lead for ACA products, including coordination with CMS and state regulators, tracking and/or completing required reporting or document submissions, and facilitating any associated audits.

Talent Management

• Hiring, training, developing, and communicating with staff.

Financial Management

• Develops, monitors, and achieves budget goals.
• Manages labor and non-labor expenses to budget or flex budget.
• Manages revenue to budget to maximize potential revenue.

EPE/Service

• Upholds PROMISE standards of direct reports and team members.

Quality

• Responsible to achieve goals for assigned area(s).
• Manages and promotes continuous process improvements in assigned area(s).

Performance Management

• Provides staff feedback on performance, including on-time appraisals and coaching.
• Deals with conflicts in a proactive manner and reaches resolution in a timely manner.

Building Relationships

• Forms positive relationships with staff, peers, and senior leadership to support the mission, vision, values, and performance standards of the organization.
• Engages staff with updates and news as well as involving staff in decisions and work teams.
• Provides feedback and recognition when appropriate.

Knowledge / Skills / Abilities

• Ability to perform the functions of the position, as outlined above.
• Demonstrated strong verbal and written communication skills.
• Knowledge of applicable statutes and regulations including Utah insurance requirements, ACA provisions, ERISA, Medicare, False Claims Act, Anti-Kickback Statute and Stark Law.
• Strong understanding of health insurance operations.
• Experience performing regulatory analysis, oversight, and internal audits.
• Experience facilitating external audits.
• Ability to assess complex situations and prioritize projects.
• Excellent interpersonal skills, with ability to build collaborative internal relationships.
• Knowledge of the federal and state insurance regulatory environments.
• Strong analytical and project management skills.
• Self-Motivated, with the ability to work under moderate supervision.

Required Qualifications

• Bachelor's degree in Health Care Administration, Business Administration, or related area.
• Five years of regulatory compliance, or equivalency.

Preferred Qualifications

• (Preferred) Master's degree in Health Care Administration, Business Administration, or related area.
• Certification in healthcare compliance or compliance and ethics, such as Certified in Healthcare Compliance (CHC) or Certified Compliance & Ethics Professional (CCEP).
• Experience in HIPAA Privacy compliance.
• Seven years of relevant experience.