Vice President, Wellsense Compliance Officer

POSITION SUMMARY:
The Vice President, WellSense Compliance Officer develops and leads the execution of compliance related strategies for WellSense Health Plan, working with WellSense executive leadership and business departments. The Vice President, WellSense Compliance Officer oversees the WellSense compliance program initiatives across the business to protect the interests of WellSense and BMC Health System. The Vice President, WellSense Compliance Officer reports to the Vice President, Chief Compliance Officer of BMC Health System with a "dotted line" reporting relationship to the WellSense President, and is a member of the BMC Health System Compliance Department. This position offers the opportunity to work fully remote, while being part of a great team culture and growing company.
Position: Vice President, WellSense Compliance Officer
Department: Compliance
Schedule: Full Time
ESSENTIAL RESPONSIBILITIES / DUTIES:

• Leads compliance solutions for Wellsense and ensures the elements of an effective compliance program are in place in accordance with all rules and regulations.
• Primary contact for Wellsense compliance with local, state and federal agencies
• Develops, implements, and leads a proactive, strategic approach for collaborative engagement with internal and external business partners (including Public Partnerships, Government Affairs, Legal, and other operational departments) and government agencies to support WellSense business goals and serves as a role model for the entire team able to make executive decisions and ensure Compliance is a strong, influential voice and advocate for WellSense and BMC Health System.
• Oversight of Wellsense Compliance policies and procedures, including updating in accordance to local laws and practices.
• Responsible for ensuring that all the subordinate functions within Wellsense are compliant with their respective regulations and laws
• Oversees the Medicare and Medicaid Compliance Officer to ensure compliance with CMS and other federal/state compliance requirements governing WellSense products, including oversight of state and federal audits and OFCCP.
• Actively engages and maintains effective working relationships with executive leadership and other staff to ensure a culture of compliance and provides sound guidance on the timeframe, impacts and magnitude of new and emerging rules and regulations affecting the business of WellSense and BMC Health System.
• Oversees compliance with the Model Audit Rule (MAR) to ensure key controls are in place to support the annual certification to the Division of Insurance by the WellSense' President and Chief Financial Officer.
• Oversees the WellSense privacy program and works closely with the WellSense Chief Privacy Officer who reports to the WellSense Chief Legal Officer with dotted line to Compliance.
• Oversees annual compliance training and other education programs.
• Provides guidance related to new products or proposed business ventures to meet regulatory compliance.
• Coordinates with BMC Health System's Conflict of Interest Officer in reviewing and developing management plans when conflicts are identified.
• Supports the management of investigations including delegation of internal compliance investigations.
• Chairs the WellSense Compliance Committee.
• Ensures effective communication on corporate compliance matters with internal staff, BMC Health System's Chief Compliance Officer, and the BMC Health System/WellSense Audit and Compliance Committee.
• Assists in the development and review of WellSense and, as appropriate, BMC Health System policies and procedures.
• Maintains an effective working relationship with corporate-wide contacts at all levels.
• Reviews work to ensure conformity to established departmental policies and procedures, objectives, audit and regulatory standards.
• Represents the department at meetings and participates on various committees as directed by the BMC Health System Chief Compliance Officer for both WellSense and BMC as required.
• Participates in activities that lead to continuous professional development, such as seminars and conferences, to keep abreast of legal developments and changes in the regulatory environment.
• Maintains membership in appropriate professional organizations and attends professional organization meetings.
• Uses BMC Health System and WellSense values as the basis for decision making and to further the mission of WellSense and the BMC Health System.
• Performs other duties as needed.
• Reads, understands, and follows the WellSense and Boston Medical Center Code of Conduct

JOB REQUIREMENTS
EDUCATION:
Bachelor's degree required (Master's and/or Juris Doctor degree desired), but not required from an accredited school.
EXPERIENCE:

• Minimum ten years of progressive experience in health care policy (including Medicaid and Medicare policy) or managed care environment.
• Proven track record of health care policy (including Medicaid and Medicare policy) and/or health plan leadership and development essential.
• Demonstrated experience in strategic planning and development.
• Demonstrated experience in working with government officials.
• Work requires knowledge of federal and state rules and regulations applicable to the healthcare industry, including familiarity with managed care, reimbursement, privacy, fraud and abuse, research, and the current regulatory environment; of office and supervisory practices and procedures at a level generally acquired through at least five to ten years of health plan compliance experience with an emphasis on health-related issues, FDR oversight, vendor management, Medicare and Medicaid.

KNOWLEDGE, SKILLS & ABILITIES (KSA):

• Work requires excellent oral and written communication skills.
• Work requires analytical ability necessary to provide compliance oversight and advice over a wide variety of issues.
• Work requires interpersonal skills necessary to provide a leadership role in ensuring the provision of sound compliance management; to maintain an effective working relationship with corporate-wide contacts including senior management; to effectively communicate with all levels of employees; to establish and maintain effective working relationships with governmental agency staff and other various outside parties.
• Work requires a working knowledge of computers including word processing and e-mail systems. Work requires the production of documents and letters with minimal support.

Equal Opportunity Employer/Disabled/Veterans