Compliance Manager - Investigations - Health Alliance Plan

Health Alliance Plan of Michigan in Troy, MI

  • Industry: Advertising/Marketing/Public Relations - Marketing Director
  • Type: Full Time
  • Compensation: $132,180.00 - 205,690.00 / Year*
position filled
GENERAL SUMMARY:

Plan, lead and manage the day-to-day operation of the Compliance Program, regulatory audit, FDR oversight, and risk assessment for all HAP and HAP subsidiary lines of business. Responsible, under the direction of the Director-Compliance, to provide overall strategic direction to manage compliance. Develop and implement compliance processes, compliance risk assessments and assist in the development of compliance education. Act as a liaison for the Compliance department, collaborating with key departments and Compliance Leads to ensure policies and procedures are designed, developed, and implemented to ensure compliance and collaborate with cross-functional teams to develop, enhance and implement departmental compliance programs to promote continued awareness and adherence to compliance. Manage audit activities related to compliance issues and violations including coordinating with business units and departments to monitor and assess violations, ensure timely investigations and corrective actions as well as tracking of violations for the purpose of annual reporting.

PRINCIPAL DUTIES AND RESPONSIBILITIES:
  • Develop and implement annual compliance work plans, risk assessments and other compliance program materials that reflect and address mitigation requirements for compliance program risks. Assist in development of policies and procedures in accordance with compliance rules and regulations.
  • Disseminate written policies and procedures related to compliance activities.
  • Manage regulatory audit program to ensure compliance procedures are followed.
  • Lead, plan, develop and conduct education and training activities related to compliance activities and topics.
  • Develop presentations and educational materials for departments and individuals at all levels to provide education and compliance regulatory updates.
  • Represent Director-Compliance when necessary to facilitate compliance committees.
  • Implement monitoring and reporting process regarding all ongoing compliance activities under the direction of the Director-Compliance.
  • Oversee the analysis and investigation of compliance violations.
  • Conduct routine audits of the compliance program.
  • Perform other duties as assigned.
EDUCATION/EXPERIENCE REQUIRED:
  • Bachelor s degree in health care
    administration, public health, business, or related field. Master's preferred.
  • Minimum
    of five (5) years experience in insurance industry which includes:
    • Experience in healthcare compliance
    • Experience with Affordable Care Act, Medicare Advantage, Part D,
      and Medicaid compliance regulations
    • Working knowledge of corporate compliance policies/procedures
  • Two (2) years
    experience in a managerial/supervisory position and with leading staff in
    projects within a health care environment preferred.
  • Certification
    or designation in health care or managed care a plus


* Estimated salary


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