The Associate Director, Compliance is responsible for establishing a baseline of compliance risk
Identifying areas of potential exposure
Developing and aligning compliance risk management strategies with CareSource goals and objectives
Executing the compliance program ensuring effectiveness
Serves as the program compliance leader for an assigned Medicaid, Medicare, or Marketplace CareSource program
Building and maintaining a strong relationship and goodwill with the relevant regulatory entity
Assist the Program or Regional Compliance Officer with the implementation of an effective compliance program
Oversee all assigned program compliance activities performed and tracked by compliance staff
Build and maintain strong partnerships with business units
Remain current and help drive interpretation and implementation of federal/state laws and regulations regarding Medicaid, Medicare and Marketplace requirements
Provide feedback to Compliance leadership concerning key risks in assigned program
Manage and drive effective usage of compliance tools and data for the compliance tracking systems
Track and trend issues to identify compliance risk and performance improvement opportunities
Assist with regulatory audits

Bachelor’s Degree in Business/Healthcare Administration or a related discipline, or equivalent years of relevant work experience
A minimum of five (5) years of relevant work experience within health plan operations is required, with at least three (2) years directly involved in government programs or managed care compliance activities preferred
Two (2) years of direct management experience is required
Specific Marketplace, Medicare and Medicaid managed care experience is required as applicable
Advanced capabilities in MS Office suite including Microsoft Word, Excel and PowerPoint
Knowledge of managed care principles, benefit design, claims processing, finance, data reporting design, and analysis
Working knowledge of health plan environment is preferred
Certified in Healthcare Compliance (CHC) preferred

Associate Director, Compliance, Managed Care

Key skills