Director, Compliance Officer Government Programs

The Director, Gov’t Programs Compliance Officer provides leadership and direction of Point32Health Government Programs Compliance Program across all lines of business. This includes identifying and having a detailed knowledge of compliance requirements; identifying compliance risks; and direct administration of activities, projects and talent necessary to ensure compliance with Medicare and Medicaid laws and regulations governing contracts with the Centers for Medicare and Medicaid Services (CMS).This role officially manages the interface with the Centers for Medicare and Medicaid Services for all compliance program matters and eads the enterprise risk identification and risk mitigation efforts for Government Programs compliance.
The Director, Gov’t Programs Compliance Officer will report to the Chief Compliance Officer and will be responsible for overseeing all elements of an effective compliance program, including development and management of risk assessment and monitoring plans, response to compliance issues, development and effective management of compliance workplans, coordinating external audits and reporting to the Compliance Steering Committee and the Board of Directors Audit and Compliance Committee. This includes supporting the Chief Compliance Officer and working collaboratively as a member of the compliance leadership team.

• Develop and execute on a strategy for a sustainable Medicare Compliance Program that is effective and efficient.
• Provide visionary as well as hands on leadership to the compliance team; leading processes and building a culture of integrity and high performance. This includeshiring, coaching, training and developing colleagues and inspiring excellence.
• Manage, document, and maintain a coordinated regulatory Government Programs Compliance Program that meets the expectations of State and Federal regulators and corporate governance programs. Ensure a high-standing relationship with CMS regulators in support of Point32Health’s products and meet the expectations and requirements of internal and external customers. Serve as primary liaison between CMS and Point32Health to respond to CMS concerns and to advance Point32Health’s business and regulatory priorities.
• Provide oversight and leadership for internal monitoring activities. Develop and implement program policies, procedures and practices designed to promote compliance with the requirements of State and Federal health care programs. Also develop and implement policies and procedures that implement components of the compliance program.
• Work with business unit leaders to increase awareness of the importance of the Compliance Program and develop and maintain positive relationships between compliance and operations staff. Attend operations staff meetings for functions with significant impact on Medicare and Medicaid Compliance.
• Work with business unit leaders to provide adequate information to ensure that they and their employees have the requisite information and knowledge of regulatory issues and requirements to carry out their responsibilities in a lawful and ethical manner.
• Manage the compliance unit’s administrative duties. This includes organizing and maintaining relevant documents; preparing necessary reports on activities; and supervising support staff, as needed. Monitor Compliance performance by operational areas. Undertake investigations of compliance inquiries, prepare reports, and monitor remediation.
• Develop external contacts to position the Company as a leader in health care compliance programs. Implement and maintain Medicare, Medicaid and FDR risk assessment process coordinated with organizational broader risk assessment process.
• Other duties and projects as assigned.

• Bachelor’s degree required; JD or Master’s degree in health care administration, public service administration or related field preferred.

• Minimum of 10 years industry experience (at least 5 years of Medicare and Medicaid Compliance experience) in people management and compliance related activities, legislative and regulatory activities, health insurance operations or legal research or equivalent combination of education and experience.
• Demonstrated knowledge of government regulations as they relate to the administration of Medicare healthcare programs, principles, and practices of managed care. Strong subject matter expertise in Medicare Operations and Compliance Requirements.
• Proven ability to work with all levels of leadership. Demonstrated effectiveness operating in complex organizational environments. Demonstrated ability to partner effectively with others in the handling complex issues
• Project coordination and management experience. Strong experience with Medicare health care products is preferred.

• Strong people leadership skills with ability to lead cross functional teams.
• Strong research, analytical, writing, public speaking and computer skills. Excellent written, oral, and presentation communication skills.
• Ability to develop and support staff in their professional development and inspire excellence.
• Strong problem-solving skills.
• Understanding of health policy issues related to medical and other healthcare activities.

• Must be able to work under normal office conditions and work from home as required.
• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
• May be required to work additional hours beyond standard work schedule.