Must be able to sit onsite in Kentucky with Louisville, KY preferred
Responsible for directing foundational and strategic compliance responsibilities with consistent excellence that support the team and management.
Primary duties with expert skill level and tasks with the most advanced complexity and broad/enterprise scale may include, but are not limited to:
- Directs projects, initiatives, regulatory sanctions, executive-sponsored initiatives, regulatory audits or exams, internal audits, accreditations, on-site reviews, risk assessments; audit planning, conducting mock audits, conducting audit training, managing audit evidence preparation, assessing audit preparedness.
- Leads compliance monitoring to identify process gaps, validate compliance levels, map processes, draft corrective actions/remediation plans, oversee implementation of corrective actions, prepare reports/presentations.
- Leads complex investigations and documents findings.
- Develops strategic plans, makes recommendations to leadership; designs/implements annual compliance plan.
- Develop strong relationships with key leaders to identify and address compliance risks and failures and manage action plans designed to fully mitigate risk(s).
- Communicates state and federal laws and regulations throughout the company
- Assists with the identification of business owners to lead implementation efforts and subject matter experts to participate on project teams; and provides enterprise-wide reporting on implementation status and compliance concerns
- Supports and provides expertise to corporate-wide projects and monitoring the development of implementation plans, gap analysis, milestone dates, and other significant aspects of corporate-wide projects
- Provides guidance to and works collaboratively with compliance areas, Legal, IT, Planning and Project Execution Units, and the Enterprise Portfolio Management Office to identify and implement improvements in the company's regulatory process
- Leads and manages enterprise-wide efforts to improve responsiveness to and consistency of company responses to market conduct exams; and provides enterprise-wide reporting on exam status, penalties and trends
- Obtains and maintains an awareness of industry regulatory trends, organizational developments, and company strategies that could impact the success of regulatory projects
- Serves as a database subject matter expert and maintains knowledge of database design, data definitions, system capabilities, and data integrity issues
- Must be able to perform all duties of lower level positions as directed by management.
Detailed Overview of Role:
- Subject matter expert of Medicaid contract, rules, regulations governing business operations and State Agency expectations with responsibility for educating and advising the business
- Primary liaison with the State Agency Contract Manager, facilitating communications between the parties and ensuring an organizational focus on meeting contractual obligations and State Agency deliverables
- Coordinates regulatory reporting deliverables, ensuring timeliness, accuracy and completeness of report and data submissions to the State Agency
- Responsible for the internal prep and management of on-site State Agency audit reviews
- Requires a BA/BS; MS/MBA/JD or professional designation preferred; 8-10 years of health care, regulatory, ethics, compliance or privacy experience; or any combination of education and experience, which would provide an equivalent background, including strong leadership/managerial skills and ability to motivate/coach other staff.
- Ability to travel may be required.
- Regulatory experience is strongly preferred
- Must be able to sit onsite in Kentucky