The Director Regulatory Compliance - Government Programs is responsible for monitoring regulatory requirements affecting CareCentrix government program operations, analyzing and documenting those requirements, communicating and educating affected business areas about those requirements, developing training programs to ensure an understanding of those requirements, and working with affected business areas to modify operations and policies and procedures to ensure compliance. This is an individual contributor role.
- Monitor federal and state laws impacting CareCentrix’s government program operations, analyze the information, and prepare and circulate written communications to affected business areas regarding such laws.
- Provide support, guidance and direction in the development of policies, procedures, and other operational changes necessary to comply with legal requirements and support the operational areas in the implementation of such policies, procedures, and other changes as required.
- Create and implement compliance tracking, trending, and reporting tools.
- Perform internal audits and identify opportunities for improvement.
- Develop and deliver training programs to ensure a clear understanding of compliance requirements.
- Assist Senior Director Regulatory Compliance in other matters as needed.
- Adhere to and participate in the Company’s mandatory HIPAA privacy program / practices and Business Ethics and Compliance programs / practices.
- Review and adhere to all Company policies and procedures.
- Bachelor’s Degree required.
- Minimum of 8 years’ experience in a managed care setting.
- Must have thorough understanding of federal and state laws impacting health insurers and their delegated entities, including but not limited to, laws impacting utilization management, claims, and credentialing for governmental health plans (Medicare or Medicaid).
- Medicare experience highly preferred.
- Competent in the use of PowerPoint, SharePoint, and Excel.
- Excellent legal research skills, attention to detail, and oral and written communication skills.