Compliance Director - AlohaCare

Apply on line at http://www.alohacare.org/Careers/Default.aspx

The Company:

AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment. As Hawaii’s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii.

The Culture:

AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication and a generous benefits package.

AlohaCare’s leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare has a strong commitment to support Hawaii’s families and reinforces a healthy work/home balance for its employees. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, employee events and quarterly all-staff meetings. AlohaCare’s comprehensive benefits package includes low-cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.

These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve.

The Opportunity:

Position Summary:

The Compliance Director promotes a culture of compliance, ethics, and integrity is responsible for supporting the Senior Vice President, Compliance and Quality (Compliance Officer) in implementing AlohaCare’s Compliance Program. The position leads and manages the Compliance Department staff. The primary job objective is to assist the organization/department and delegates to meet regulatory requirements and support quality and integrity efforts. Responsibilities include: directing Compliance programs, policies, and practices to ensure that all business units are in compliance with Medicaid and Medicare policy and reporting regulations; assisting with interpretation of federal and state rules, laws and regulations; identifying and resolving compliance related issues; developing and implementing compliance work plans, policies and procedures, and activities; monitoring and auditing division and/or department functions against regulatory requirements; educating staff on compliance and regulations; and communicating to staff and key external stakeholders compliance issues or regulatory and/or legislative changes. This position will contribute to compliance with legal, contractual, and statutory obligations for the organization’s Medicaid and Medicare products. Working closely with functional leadership, this position will also focus on continuous improvement of processes, systems, and documents, and provide oversight of projects to drive standardization and automation. The Compliance Director acts as a resource for AlohaCare’s functional areas on interpreting and applying regulations, monitoring and assisting functional areas with submission/upload of documents to regulatory bodies. Reports to Senior Vice President, Compliance and Quality (Compliance Officer).

Primary Duties & Responsibilities:

• Manages the day-to-day operations of the organization’s corporate compliance program and plan.
• Leads enterprise-wide risk assessments and develops auditing and monitoring plans
• Manages policies and procedures (P&P) program management ensuring departments review, update, and publishes P&Ps timely
• Maintains and implements Compliance and privacy P&Ps
• Assists with compliance and privacy concerns
• Coordinates and responds to regulatory audits and inquiries
• Interacts with all staff to ensure the corporation and its subcontractors comply with all state and federal laws and regulations
• Acts as a liaison with State departments to obtain regulatory approval of all policy documents and to handle any issues as they arise
• Co-chairs the Corporate Compliance Committee and subcommittees.
• Assists with the development and management of the Compliance Workplan
• Facilitates multiple state licensing/registrations for AlohaCare regulatory requirements
• Leads development and deployment Compliance communications and education
• Develops, implements, enforces, and monitors department’s goals and objectives and policies and procedures; recommends necessary changes as needed.
• Develops and implements maintenance programs, standard operating procedures, and quality and productivity improvement initiatives to improve services, efficiency, and effectiveness of the department.
• Creates functional strategies and specific objectives for the department.
• Develop and manage department budget to support the department’s functional infrastructure.
• Supports AlohaCare’s efforts to ensure that the organization meets all appropriate compliance objectives and that appropriate risk mitigation/control measures are in place.
• Ensures policies and procedures are reviewed for compliance with program regulations, insurance regulations, and regulatory requirements.
• Maintains and tracks laws and regulations
• Provides guidance to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory language.
• Active oversight of employee and vendor completion of Compliance & Ethics, Risk Management, FWA, and Privacy & Security training.
• Maintains a database of contractual agreements, HIPAA business associate agreements and associated documents.
• Facilitate contract review with outside counsel as needed.
• Develops Regulatory Compliance reports and provides information to the board of directors and executive management as necessary and appropriate.
• Provides assistance with department risk assessments, audit preparation and oversight & management of compliance throughout the organization.
• Reviews and responds in writing to escalated inquiries from members, providers and business partners.
• Supports compliance team members in conducting compliance investigations, audits and reviews.
• Demonstrates collaboration, teamwork and interpersonal skills conducive to a professional work environment.
• Performs other duties and responsibilities, as assigned.

Required Competencies & Qualifications:

• Bachelor's Degree
• Minimum of 4 years managerial/leadership position experience
• 3-5 years of experience in health plan operations
• Experience with Medicare and Medicaid programs required or equivalent experience
• Knowledge of managing an effective compliance program
• High level of knowledge of the overall departmental functions
• Strong written, verbal, and presentation skills
• Technical writing expertise
• Ability to work independently and manage own work assignments with minimal supervision
• Working knowledge of Microsoft Excel, Word, and PowerPoint
• Proficient knowledge of spreadsheets/graphics, presentation, and databases
• Understanding of investigational processes and standards
• Strong analytical skills, communication skills, and relationship skills
• Ability to work on multiple projects concurrently and prioritize tasks appropriately
• Ability to read, analyze, and interpret complex documents including but not limited to new regulations, laws, etc
• Ability to make effective and persuasive presentations on controversial or complex topics
• Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions and deal with several abstract and concrete variables.

Preferred Qualifications

• Juris Doctor Degree

Physical Demands/Working Conditions:

• Requires operation of computer workstation, including keyboard and video display terminal.
• Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.

Salary range: $110,000 - $140,000 annually

AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record), disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans’ status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.