VP of Compliance

Location: Tacoma, WA
Date Posted: 03-08-2018
Vice President of Compliance Operations - Managed Care
Tacoma, WA 
Job Summary:
Coordinate, negotiate and direct the activities of the Medicare Compliance program and department staff to facilitate performance of all health plan responsibilities related to Medicare.  Including developing and implementing budgets and market planning; ensuing compliance of health plan/provider contracts; managing departmental workflow; and ensuring staff and program is in line with all related regulations. The Director of Medicare Compliance Operations is responsible to aid the chief administrative officer in formulating and administering organization policies and procedures related to meeting federal, state, and company Medicare regulations.
Position Description: 
  • Oversee, administer, and implement various aspects of the Medicare Compliance program, including Health Plan Management System (HPMS) communication and regulation.
  • Ability to research and apply CMS, DOI, OIG, and HIPPA regulations to create processes and strategies while ensuring corporate compliance.
  • Coordinate and document company responses to Centers for Medicare & Medicaid (CMS) Requests for Information and related responses.
  • Provide guidance to various departments regarding compliance issues and ensure implementation of new compliance requirements with respect to regulatory and contract language.
  • Identify, evaluate and analyze the impact of CMS and Medicare regulatory issues and advise management concerning impact.
  • Partner with various departments to ensure that state and federal regulatory requirements are communicated and met.
  • Maintain and track laws and regulations, contract documentations, amendments, and various compliance measures
  • Ensure all Medicare products and services are being tested for compliance with program regulations, insurance regulations, and regulatory requirements for business entities.
  • Develop policies, procedures, and process to comply with federal program regulations, and any applicable state regulations; ensure policies and procedures are updated according to CMS and contract requirements.
Background Profile:
Clinical or Non-Clinical Professional with a Bachelor's Degree in Business, Leadership, or Health Care field.
Around 7-9 years of compliance experience, preferably in a health care environment.
Around 3-4 years’ experience working for a Managed Care Organization (Health Plan, IPA, TPA, MSO, etc).
Roughly 3-4 years previous management experience, in roles of increasing responsibility; preferably as a Director or large scale Program Manager for a Managed Care Organization.
Broad-based background in health care and medical management is essential.
1-2 years demonstrated experience with contract negotiations and/or provider networking.
Requires knowledge of managed healthcare as applied to government sponsored programs.
Basic computer proficiency (MS Office and Healthcare IT Systems) and typing skills are necessary.
Understanding of operational reports, finical budgeting processes, and health care payment models.
Excellent verbal and written communication skills, as well as exceptional critical thinking skills.
Strong oral and written communication skills; ability to interact with internal and external contacts.
Possess planning, organizing, conflict resolution, negotiating and interpersonal skills.
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