Executive Job Description | VP of Compliance -Baton Rouge, LA
Opportunity to join an established and growing organization. Ensure regulatory compliance with state Medicare, Medicaid program and state health care cost containment activities for a new state health plan, corporate and its business subsidiaries.
Ensure state health plan and corporation are in compliance with federal and state Medicare and Medicaid regulations, insurance regulations, regulatory requirements for business entities and state contract requirements.
Develop and maintain records of Medicare and Medicaid contracts, contract amendments, compliance measures and improvements, policy, procedure and process documentation.
Develop policies, procedures and processes to comply with state law, federal law and state contract requirements.
Train health plan staff of new policies, procedures and processes to comply with new state law, federal law and state contract requirements.
Oversee the Billing Errors, Abuse and Fraud program at the health plan level. Serve as the primary local contact for BEAF reports and liaison with the Corporate Special Investigations Unit (SIU).
Provide guidance to internal state health plan and corporate departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language.
Balance reporting requirements to multiple constituencies including; corporation regional vice president, state health plan president, chief operating officers and Corporate regulatory and government affairs staff.
Oversee the health plan privacy program.
Chair, participate in, attend, and plan/coordinate, staff, departmental, committee, sub-committee, community, State and other activities, meetings and seminars. Serve on Senior Executive and management committees, as well as direct special projects or studies.
Investigate areas of non-compliance and initiate corrective action where necessary.
The successful candidate will hold a Bachelor's degree in Public Policy, Government Affairs, Business Administration or equivalent. At least 5 years of relevant experience. Extensive knowledge of state administrative code and regulations, Medicare, Medicaid and 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. Masters or Law degree preferred.
ABOUT THE COMPANY:
Our client is one of America's premiere managed medicaid companies. You'll enjoy a comprehensive benefits program, very competitive salary and generous bonuses. FULL relocation package.
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