Job: Director of Compliance - Compliance

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Jobing Description

Category: Leadership/Management
Facility: Phoenix Health Plan/Abrazo Advantage Health Plan
Department: Compliance
Schedule: Full Time
Shift: Day Shift
Hours: 80
Job Details:Overview: Directs and coordinates the Health Plan’s efforts to ensure compliance with laws, regulations and policies that govern its Medicaid line of business. Primary duties include:

Directs and coordinates the Health Plan’s efforts to ensure compliance with governmental contracts, laws, regulations and policies that govern itsMedicaid program.
Implements, documents, and maintains a coordinated legislative and regulatory compliance program that meets the expectations of government regulators and parent company.
Monitors the implementation of corrective actions and /or process improvements identified from internal auditing and monitoring activities as well as those developed in response to external review for all lines of business. Presents written summaries of auditing and monitoring activities, including recommendations for corrective action and/or for process improvement for all government programs to CEO.
Coordinates resources to ensure the ongoing effectiveness of the Medicaid compliance program. Develops and/or ensures internal controls are capable of preventing and detecting significant instances or patterns of illegal, unethical, or improper conduct. Has the authority to report any identified concerns directly to governmental regulators without the prior approval of the CEO.
Is the health plan authority on governmental contracts and manages changes to documents to ensure all policies and procedures are in alignment.
Identifies and assesses areas of compliance risk for the health plan.
Presents periodic reports and quarterly evaluations on the compliance program to the health plan compliance committee, CEO and EMC.
Organizes the compliance committee, PRAC and the Policy and Procedure committee, including developing appropriate agendas, reports and information as requested by the committee, CEO and/or EMC
Is authorized to stop the submission of data that he/she believes contains material errors.
Coordinates site visits for Federal and State regulators.
Coordinates or oversees regulatory submissions and reporting activities. This includes maintaining working relationships with regulators and others to clarify and resolve issues.
Tracks all issues referred to the compliance unit up to and including resolution.

Special Skills: Strong writing and communication skills. Ability to leads subordinates to achievement of goals. Reconciliation functions, strong analytical and organizational skills with attention to detail. Proficiency in applying and interpreting rules associated with regulations, CMS, DOI and AHCCCS applications and tools.

Minimum Requirements: High School diploma with extensive financial experience. Bachelor's Degree in Accounting, Finance, Business or related field preferred.
Preferred Qualifications: Bachelor's Degree in Accounting, Finance, Business or related field preferred. Experience in commercial healthcare, Medicaid managed care, and/or AHCCCS/CMS related lines of business. 5+ years experience in managed care.

Skills / Requirements

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