The Director of Health Plan State and USFHP Compliance serves as a liaison between the Defense Health Agency, as well as state governments where the health plan operates. He/she is also responsible for compliance oversight of the Health Insurance Exchange program with CMS. The Director of Health Plan State and USFHP Compliance is responsible for the review of deliverables to these agencies and ensures timely submission of information.
- Supervise and manage the selection, training, development, appraisal, and work assignments of team associates.
- Instill a high-performance culture in the team with a focus on teamwork, service excellence and ownership for resolving issues. Set standards for and complete evaluations of direct reports. Set standards for and complete evaluations of direct reports.
- Submit daily, weekly, monthly, quarterly and annual reports as requested and as per contract and regulatory specifications.
- Ensure compliance procedures and practices are well defined, documented and consistently applied.
- Interfaces with compliance oversight committees, regional and entity leadership, legal counsel, and other related parties to represent the organization's interests with external parties (state or local government agencies) who adopt or amend legislation, regulations, or standards.
- Implement and execute auditing, monitoring, tracking, and reporting to ensure the success of the health plan compliance program. Ensure that systemic processes are in place to address and mitigate compliance risks and identified issues.
- Serves as a product manager liaison between the health plan and the Defense Health Agency. Reviews rules to ensure compliance with requirements.
- Communicates to operational leaders the compliance implications of existing and new laws and regulations as they pertain to various CHP entities. Works closely with legal counsel to ensure proper interpretation of the applicable laws and regulations.
- Responsible for coordinated and tracking external regulatory oversight audits.
- Ensures department's compliance with DoD, CMS/CCIIO, TDI, OSI, LDI, and other applicable regulatory, NCQA and URAC standards, including the Health Insurance Exchange. Initiates remediation and corrective action plans when compliance deficiencies are identified.
- Collaborate with all other departments as appropriate and required to facilitate the completion of required regulatory reports. Reviews the submission of data to regulatory bodies to ensure that it is accurate and in compliance with reporting requirements.
- Follows the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability ACT (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI).
- Education: Bachelor's Degree in Business Administration, Healthcare Administration or exemplary experience required.
- J.D. preferred.
- Strong presentation, analytical and negotiation skills.
- Strong oral and written communication skills.
- Ten (10) or more years of substantive health plan experience, with increasingly progressive responsibility. Compliance experience strongly preferred.
- Knowledgeable and compliant with all relevant laws, rules regulations, accreditation standards, and requirement.
C. Licenses, Registrations, or Certifications