Senior Vice President Compliance

 
Location: Milwaukee, Wisconsin
Posted On: 9/7/2017
Job Code: 3026_SVPC_WI
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Job Description
 
Job description
Position Purpose: Ensure regulatory compliance with state and other government agencies related to the health insurance industry, and its business subsidiaries.

• Develop and implement strategic vision for compliance and ethics culture within the business unit ensuring alignment with Corporate

• Ensure business unit are in compliance with state and federal program regulations, insurance regulations, regulatory requirements for business entities and state contract requirements

• Develop policies, procedures, and processes to ensure compliance with state law, federal law, contract requirements, and various standards

• Oversee compliance integration and support of business operations and support units

• Oversee, administer, and implement various compliance programs, including fraud and abuse and HIPAA

• Provide guidance to various departments regarding compliance issues and implementation of new compliance requirements related to regulatory and contract language

• Develop strategic relationships with state and federal regulators and assist with the development of internal and external policies concerning state insurance, Managed Care Organization, Medicare and Medicaid regulations and initiatives

• Identify, evaluate and analyze the impact of state and federal, regulation, policy and contract requirements; resulting issues, develop positions, alternatives, recommendations advise management concerning impact

• Oversee fraud and abuse programs on the health plan level, collaborating with the special investigation unit team and serving as main regulatory liaison

• Oversee development or adoption of Corporate’s special investigation, ethics and compliance training to include delivery, monitoring and reporting

• Conduct compliance monitoring, develop and implement performance improvement plans, corrective action plans, and report on achievement of action plans to senior management

• Oversee the maintenance and tracking of laws and regulations, contract documentations, amendments, and various compliance measures and ensure appropriates are taken to address changes
Qualifications:

Education/Experience:
• Bachelor's degree in Public Policy, Government Affairs, Business Administration or related field.
• 10+ years of compliance program management and contract experience.
• Extensive knowledge of state administrative code and regulations, state insurance laws and regulations including managed care regulations.
• Experience with state and federal government agencies, accreditation bodies, participating provider agreements, HIPAA and Third Party Administration (TPA) laws, credentialing regulations and prompt pay laws.
• Master’s or Law degree preferred.
• 15+ years of program management and contract experience preferred.
Category:IT  code:new
 
 
Job Requirements
 
 
Compliance, Management, Program Management, STE, Training
 

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Contact Details
 
Recruiter
Divyanshu Kumar
 
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