Senior Vice President, Compliance

Confidential Company  •  Milwaukee, WI

11 - 15 years experience  •  Legal Services

$180K - $200K
Posted on 08/10/17 by Kevin Rogers
Milwaukee, WI
11 - 15 years experience
Legal Services
$180K - $200K
Posted on 08/10/17 by Kevin Rogers

Position Purpose: Ensure regulatory compliance with state and other government agencies related to the health insurance industry, Centene Corporation, 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 contractlanguage
  • 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 contractexperience. 
  • 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 Lawdegreepreferred.
  • 15+ years of program management and contractexperiencepreferred. 
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