Director, Compliance Medicare

The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

We are hiring a Director, Compliance Medicare to join our team!

Must reside in California - remote position.

Summary

Under limited supervision, the Director of Compliance (Medicare) is responsible for developing and overseeing the implementation of strategic and operational objectives and plans according to best practices, internal and external requirements, with a focus on Centers for Medicare & Medicaid Services (CMS), and in support of organizational strategy. Work is highly varied and complex and requires a moderate degree of discretion and independent judgement.

Supervises

Program Manager (Medicare)

Essential Functions

• Leads HPSJ's regulatory compliance efforts with CMS and other relevant federal regulatory agencies.
• Serves as the subject matter expert for management and staff on the conditions and terms of CMS contracts, and other external laws and regulations; collaborates to ensure compliance and alignment.
• Identifies, develops, plans and executes strategies, participating with peers and others to ensure effective integration; oversees the development and implementation of department goals and actions plans.
• Performs validation reviews and risk assessments to evaluate Medicare contract requirements and business processes; ensures appropriate documentation in compliance systems.
• Oversees the implementation and completion of CMS regulatory corrective action plans and other compliance activities.
• Manages the Medicare or other Medicare-related audits and coordinates with Audit & Oversight team on activities related to risk assessment, preparation and facilitation; monitors results, escalation issues, notices of non-compliance, warning letters, corrective action plans, fines, penalties, and/or sanctions.
• Responds to reports of Medicare regulatory non-compliance, including the coordination of internal investigations with relevant functional areas, and the development of appropriate corrective or disciplinary actions, if necessary.
• Collaborates with Medi-Cal Program team to implement, monitor and track the Compliance Program, including program metrics, structure and processes; identifies and communicates risks; develops actions plans to address.
• Collaborates with Medi-Cal Program team to create and coordinate educational training programs to ensure that HPSJ's Workforce, Commissioners and third parties are knowledgeable about HPSJ's Compliance Program, its written Code of Conduct, compliance policies and procedures, and all applicable statutory and regulatory requirements.
• Collaborates with Program Integrity Unit (PIU) on investigations relative to FWA, HIPAA violations and other compliance issues or violations as required.
• Collaborates with the Policy Program team in the development and implementation of policies, procedures and practices designed to ensure compliance with the requirements set forth by the CMS contract, laws, regulations and health care program requirements.
• Serves as a backup chair for the Compliance Committee; ensures meeting minutes are completed and archived.
• Develops and manages department budget.
• Oversees the development, implementation and maintenance of the appropriate and required data, records, reports and other documentation.
• Promotes, maintains and ensures that direct reports promote and maintain an environment that supports HPSJ's strategy, vision, mission and values.
• Hires, develops, supervises and retains, and ensures direct reports hire, develop, supervise and maintain, an adequate and competent staff.

Non Essential Functions

Other duties as required

Education and Experience

Required

• Bachelor's Degree in a related field; and
• 10 years of experience in Medicare managed care compliance including two years in a management role in a health plan or managed care setting;
• At least six years supervisory experience; or
• Equivalent combination of education and experience.

Preferred

• Certified in Healthcare Compliance (CHC) or comparable industry certification
• Master's Degree in business, healthcare, public health, or JD
• Strong Project Management experience

Knowledge, Skills and Abilities

Required

• Expert knowledge of and ability to apply and facilitate the adoption of compliance best practices.
• Expert knowledge of community, state and federal laws and resources as they related to managed care operations.
• In-depth knowledge of managed care principles and practices as they relate to compliance.
• In-depth knowledge of the business, economic, demographic and political trends and developments affecting healthcare and managed care in general.
• Financial acumen: Interprets and applies understanding of key financial indicators to make better business decisions.
• Strong skills in budget development and management.
• Manages complexity: Makes sense of complex, high quantity, and sometimes contradictory information to effectively solve problems.
• Decision quality: Makes good and timely decisions that keep the organization moving forward.
• Strategic mindset: Sees ahead to future possibilities and translates them into breakthrough strategies.
• Ability to create, execute and monitor relevant strategic and business plans.
• Advanced problem solving and analytical skills, with ability to interpret and determine the impact of complex laws, regulations and other documents, analyze and resolve complex problems of broad scope, develop effective action plans and implement to successful conclusion.
• Ability to exercise keen judgement in difficult situations, balancing the competing interests of executive team and business areas in an effective and professional manner.
• Advanced leadership skills, including but not limited to the ability to support corporate objectives, establish direction, build alliances, and inspire and motivate others across the organization and externally.
• Strong collaboration skills, including but not limited to the ability to create and foster a collaborative work environment, and organize people and resources to solve problems and identify opportunities.
• Strong interpersonal skills, including the ability to establish and maintain effective working relationships with individuals at all levels inside and outside of HPSJ.
• Strong oral and written communication skills, including the ability to communicate professionally and persuasively to diverse individuals and groups inside and outside of HPSJ.
• Advanced presentation skills, including but not limited to the ability to tailor presentations to a specific audience, be persuasive and identify key messages.
• Builds networks: Effectively builds formal and informal relationship networks inside and outside of the organization.
• Organizational savvy: Maneuvers comfortably through complex policy, process and peoplerelated organizational dynamics.
• Persuades: Uses compelling arguments to gain the support and commitment of others.
• Resourcefulness: Secures and deploys resources effectively and efficiently; organizes people and resources to solve problems and identify opportunities.
• Plans and aligns: Plans and prioritizes work for self and others to meet commitments aligned with organization goals.
• Ensures accountability: Holds self and others accountable to meet commitments.
• Drives results: Consistently achieves results, even under tough circumstances.
• Manages ambiguity: Operates effectively, even when things are not certain or the way forward is not clear.
• Strong project management skills, including the ability to manage organizational-wide projects to successful conclusion.
• In-depth knowledge of change management theory, with ability to anticipate and implement effectively.
• Demonstrated ability to articulate and support HPSJ's vision, mission, values and strategy, integrate into management practices, and foster their manifestation among staff.
• Strong management skills, including but not limited to the ability to supervise staff in a manner that maximizes employee performance and business results.
• Intermediate skills in Word, Outlook, Power Point, Visio and Excel.
• Ability to speak and be understood in English.
• Ability to handle confidential information with appropriate discretion.

Preferred

None.

Physical Demands

Frequent sitting, standing and walking, constant repetitive motion, constant talking and listening, occasional handling of materials up to 10 lbs., close up and distance vision requirements, occasional travel.

Emotional/Psychological Demands

Ability to cope with a fast paced work environment, working under pressure, dynamic priorities and deadlines, constant decision making, working irregular hours, occasional public contact, and sensitive situations.

Work Environment

Open office environment; moderate temperatures; moderate noise levels.

Eligible for remote work.

We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.

HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics, or is associated with anyone who has or is perceived to have these characteristics.

Important Notice: This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.