Overview: The Vice President, Compliance, Privacy and Delegation, is responsible for leading a variety of enterprise-wide compliance functions including both corporate and operational compliance, vendor oversight, delegation, practitioner credentialing and audit services. This role will lead ComplexCare Solutions' Corporate Compliance Program and have direct interaction with C-Suite executives and other senior management to advance compliance objectives and provide strategic direction in support of business objectives. The incumbent will also advise on compliance requirements and risk-based strategies in support of product development, business expansion and growth initiatives.

Duties and Responsibilities:

Serve as the Company's subject matter expert for compliance, privacy and risk management functions;
Function as the Company's primary compliance point of contact both internally and externally to effectively represent Company interests and demonstrate compliance effectiveness;
Manage a multi-disciplinary compliance team that performs a variety of day-to-day delegation and compliance functions such as client audit responses, management of attestations, complaint management, internal monitoring and audit activities;
Lead compliance activities associated with state regulatory requirements and physician professional corporation operations;
Lead and conduct risk assessments and ensures implementation of training programs and compliance workplan;
Direct and manage the Company's privacy/HIPAA program intended to achieve compliance with HIPAA and other relevant privacy laws;
Review of the compliance and regulatory aspects of client and vendor contracts to ensure that Company interests and regulatory requirements are properly addressed;
Develop and lead vendor compliance program for purchased products and services;
Oversee and investigate compliance and privacy incidents/Hotline reports and implement resolution strategies;
Oversee the enterprise-wide provider credentialing functioning;
Direct and lead the delegation function which includes managing policy reviews, leadership of all delegation oversight functions; ensuring that delegates are meeting contractual obligations; and, assuring compliance with Centers for Medicare and Medicaid Services (CMS) regulations, National Committee for Quality Assurance (NCQA) standards and other relevant guidance;
Oversee the coordination and implementation of client corrective action plans for compliance, regulatory and delegated areas;
Represent Complex Care Solutions on client calls and other audit, delegation and credentialing meetings;
Maintain compliance with Complex Care Solutions' policies, procedures and mission statement;
Adhere to all confidentiality and HIPAA requirements as outlined within Complex Care Solutions' Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position;
Fulfill those responsibilities and/or duties that may be reasonably provided by Complex Care Solutions' for the purpose of achieving operational and financial success of the Company; and
Other duties as assigned.

Job Requirements:

Minimum of twelve (10) years of prior compliance experience which may include risk assessment and audit experience;
Minimum of seven (7) years of prior experience managing teams and direct reports;
working knowledge of key laws and regulations that apply to provider compliance, including, but not limited to, Anti-Kickback Statute, Conflicts of Interest, and Medicare and Medicaid program requirements;
Prior work experience in the healthcare industry is preferred;
Experience with monitoring and ensuring compliance with state regulatory requirements and experience in interpreting state and federal laws;
Knowledge and direct experience with CMS compliance program requirements;
Knowledge of state and federal regulatory bodies such as CMS and NCQA;
Regulatory compliance experience and health care compliance programs experience strongly preferred;
Compliance experience in risk adjustment is a plus;
Must excel in fast-paced environment with a broad set of diverse stakeholders;
Highly professional demeanor, communication style and approach, analytical and critical decision-making, investigational skills.
Effective verbal and written communication skills and interpersonal skills with the ability to effectively listen and communicate to varied levels;
Strong problem solving, risk analysis, and project management skills and the ability to work with minimal supervision; and
Professionally skilled in personal presentation, verbal, and written communication.

Education:

Bachelor's Degree or equivalent work experience required; and
Compliance related certification preferred.

Physical Demands and Work Environment:

Sedentary work (i.e. sitting for long periods of time);
Exerting up to 10 pounds of force occasionally and/or negligible amount of force;
Frequently or constantly to lift, carry push, pull or otherwise move objects and repetitive motions;
Subject to inside environmental conditions; and
Travel for this position will include less than 5% locally usually for training purposes.

The actual base pay offered may vary depending on multiple factors including, but not limited to, job-related knowledge/skills, experience, business needs, geographical location, and internal equity. At Inovalon, it is not typical for an individual to be hired at or near the top end of the range for their role, and compensation decisions are dependent upon the facts and circumstances of each position and candidate.

Base Compensation Range

$200,000—$215,000 USD

Studies have shown that women and people of color are less likely to apply for jobs unless they believe they meet every one of the qualifications listed in a job description. If you don't meet every qualification listed but are excited about our mission and the work described, we encourage you to apply regardless. ComplexCare Solutions is most interested in finding the best candidate for the job and you may be just the right person for this or other roles.

By embracing diversity, equity and inclusion we enhance our work environment and drive business success. ComplexCare Solutions strives to reflect the diversity of the communities where we operate and of our clients and everyone whom we serve. We endeavor to create a culture of inclusion in which our associates feel empowered to bring their full, authentic selves to work and pursue their professional goals in an equitable setting. We understand that by fostering this type of culture, and welcoming different perspectives, we generate innovation and growth.

ComplexCare Solutions is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status. We also consider qualified applicants regardless of criminal histories, consistent with legal requirement.

The Company maintains a drug free work environment for all of its associates, which includes employees, contractors and vendors. It is unlawful for associates to manufacture, sell, distribute, dispense, possess or use any controlled substance or marijuana in the workplace and doing so will result in disciplinary action, up to and including termination of employment or the contracted relationship.

ComplexCare Solutions jobs

VP, Compliance, Privacy & Delegation