Director Of Compliance

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Director of Compliance
Responsibilities: Supports the ongoing operation and sustainability of the Health Plan from a compliance perspective, which includes conducting analysis, documenting findings and summarizing the complexities in a manner that is easily understood, actionable and supports the Health Plans effectiveness. Designs, implements and improves processes to prevent, detect and respond to compliance issues and concerns related to all federal and state regulatory requirements and contract requirements. Manages approval and submission of timely and accurate contract and regulatory required report deliverables. Works on fraud, waste and abuse program including working with data analytics to identify patterns of potential fraud, waste and abuse. Serves as an organizational resource (both externally and internally) relating to health plan regulatory compliance matters. Conducts thorough research and provides prompt, courteous consultative services regarding compliance matters. Assists in developing and disseminating topic-specific education to Health Plan personnel based on identified risks or changes in law or regulation. Uses data analytics to develop and track Health Plan performance with regards to compliance standards. Works collaboratively with leadership to validate efficacy of the data to support compliance with legal and regulatory requirements. Implements an organizational framework for monitoring the federal and state regulatory landscape related to the Health Plan and to identify new developments and changes that impact the organization. Works with leaders to communicate requirements and responsibilities. Manages submission of consumer and provider communication materials, including participation in their review and timely submission to HHSC and the TDI, where applicable. Conducts on-going assessment for areas of regulatory compliance risk within the Health Plan, and, in close collaboration with Internal Audit, develops an annual compliance auditing and monitoring plan. Oversees creation and implementation of corrective action plans to reduce or eliminate risk resulting from non-compliance with contract requirements or performance deficiencies. Participates in new business implementations, including the identification and tracking of required contract report deliverables and assist with readiness review assessments.

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