Nashville, Tennessee
Glen Burnie, Maryland
Baltimore, Maryland
Gainesville, Georgia
Posted: 21-Nov-23
Location: Irving, Texas
Salary: Open
Categories:
Internal Number: 16851500
Summary:
Reporting to the Director of Health Plans Compliance (Director), the Manager of Health Plans Compliance (Manager) will support CHRISTUS Health Plans (CHP) in developing and maintaining an effective Compliance Program. The Manager is responsible for executing the Health Plans' Compliance Work Plan with particular focus on the auditing and monitoring, policies and procedures, education, and communication elements.
- Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
- Assists the Director in assessing and facilitating CHP's compliance with all applicable laws and regulations for each of CHP's business lines.
- Develops strong relationships throughout organization to foster an advisory and proactive approach to compliance.
- Helps to ensure effective training is provided for HIPAA Privacy/Security, Fraud, Waste, and Abuse, Code of Ethics, and other Health Plans compliance risk areas.
- Supports the development of an infrastructure through which CHRISTUS continuously reviews standards, regulations, and develops plans for compliance, and addresses issues of non-compliance as identified.
- Develops and executes a communication plan to keep compliance top of mind for Associates and educates them on high-risk areas and legal/regulatory changes.
- Manages CHP Compliance policies and helps management ensure that effective operational policies, procedures, and controls are in place for compliance risk areas.
- Performs organization audits to assist in determining regulatory compliance. Works with business department managers to ensure corrective action plans are developed and reports results to Director.
- Responsible for understanding and keeping current on applicable regulations for all CHP business lines.
- Conducts regularly scheduled meetings to communicate issues regarding on-going work issues, new developments, and overall effectiveness.
- Strong attention to detail with a mindset toward the operationalization of compliance requirements.
- Demonstrated aptitude with project management and diligence in addition to strong analytical and organizational skills. Reports must be current, technically complete and submitted timely.
- Communicates effectively both orally and in writing.
- Strong verbal and written communication skills.
- Intermediate/Expert knowledge of Microsoft Office Suite (Access, Power Point, Excel, Word). Other duties as assigned.
Requirements:
- Bachelor's degree in related field required.
- Five years of health plan compliance experience required, of which three years should be in Medicare, Health Insurance Exchange and/or US Family Health Plan (TRICARE).
- Demonstrated experience in regulatory deliverables, investigations, training, reporting, SIU, FDR, oversight, OIG, and managing organization-wide projects, performance enhancement efforts, and State and Federal regulatory research and regulatory compliance highly preferred.
- Experience leading organization-wide projects preferred.
- Knowledge of healthcare payor issues and State and Federal regulatory environments.
- Knowledge of healthcare privacy and security laws/regulations, including, but not limited to, the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
- Certified in Healthcare Compliance (CHC) preferred.
Work Type:
Full Time
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