Job Description

Management/ Professional

Steward Health Care Network

Steward Health Care Network

Req Number:

Job Details:

Position Purpose:

As part of the Steward Health Care Network team, the Compliance Lead is responsible for developing, implementing and monitoring the overall compliance program for Steward Health Choice (Medicaid). May also assist with developing, implementing and monitoring compliance for Medicare and commercial lines of business.

Ensure compliance with state and federal laws, regulations, mandates, and contract requirements, including:

* Monitor changes to laws and regulations to confirm compliance or adapt program to comply as needed

* Oversee data use agreement standards for all program data/PHI

* Conduct periodic privacy reviews to confirm personnel properly safeguard PHI and confidential information

* Oversee the development and implementation of the compliance plan

* Research, investigate and review compliance and privacy issues including allegations of potential fraud, waste and abuse

* Drive the development of the annual compliance work plan utilizing a risk-based approach to ensure identified risk areas have the appropriate oversight

Establish, organize, update and maintain policies and procedures for regulatory compliance (external-facing) as well as internal standard operating procedures. Includes annual review of existing policies and procedures.

Develop and review Corrective Action Plans (CAP's) to ensure areas of non-compliance are mitigated and plans are implemented timely.

Coordinate with business and operations teams to prepare and monitor submission of timely and accurate responses to routine, recurring, and ad hoc regulatory deliverables/requests

Partner with operational and compliance leadership to provide reports summarizing compliance activities including progress on annual work plan

Proactively prepare for program and performance audits, including conducting internal audits to confirm compliance with contract and other regulatory requirements. Provides written audit reports, identifying risks and recommending appropriate next steps to improve compliance effectiveness.

Develop communications and training, including regarding policies and procedures, state and federal laws, regulations, and contract requirements

Serve as Steward lead with regulators for all contract compliance matters, including meetings with designated oversight personnel from regulators

Other duties related to compliance as assigned.

Education / Experience / Other Requirements

* Bachelor's degree required.

Years of Experience:
* 3+ years compliance experience

Work Related Experience:

* Experience with managed care required; experience with Medicaid managed care preferred

* Experience with oversight and monitoring of HIPAA privacy and security regulations

* Certification in Healthcare Compliance (CHC) preferrede

Specialized Knowledge:

* Excellent communicator and able to communicate to all levels of the organization.

* Focuses on "serving" and improving the member/patient experience

* Demonstrates ability to apply principles of critical thinking.

* Possesses specialized knowledge related to health care compliance with health plans and/or providers

* Possesses strong interpersonal written and oral skills

* Possesses excellent time management skills with proven ability to effectively manage multiple tasks and priorities at one time.

* Strong project management skills to track and close all identified action items in connection with compliance program

* Demonstrates knowledge of managed care concepts for various health plan and capitated programs.

* Ability to work as part of a team and collaborate with colleagues in a highly matrixed environment

* Accepts flexibility in work schedule willingly. (e.g. periodic early morning or evening meetings)

* Requisite poise, judgment, and trustworthiness to represent Steward to internal and external groups

* Demonstrated ability to handle sensitive and confidential information with absolute discretion, as this position has access to sensitive and confidential information, records, etc. necessary to satisfactorily conduct and report on auditing and monitoring activities

* Ability to adapt and respond to changes in environment and priorities

* Strong knowledge of standard computer software tools, including Microsoft Word, Excel, PowerPoint, Outlook; Visio, Project, and Sharepoint.

Physical and Mental Demands:

These physical and mental demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
* Must be able to effectively communicate with internal and external customers via telephone and email.
* Able to accurately receive information through oral communication.
* Able to accurately review data and figures both in hard copy and electronic formats.
* Utilize a computer (including but not limited to a mouse and keyboard) and telephone intermittently throughout entire shift, for periods of up to four (4) hours at a time.
* Able to accurately sort through data and think through issues in a time?pressured environment.
* Able to focus on a specific event or activity for up to four (4) hours at a time without interruption.
* Able to maintain a calm and collected presence while addressing the concerns from an internal and external customer
* Able to accurately learn and retain new information, knowledge and skills.
* Able to efficiently manage multiple tasks, with varying degrees of priority, at the same time.
* Some travel may be required.

Application Instructions

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