Chief Compliance Officer

Job Summary

The Chief Compliance Officer is a senior leader of the health plan's management team and serves as the focal point for all compliance activities. The Chief Compliance Officer reports to the Chief Executive Officer with a direct reporting relationship to the Board of Governor's Compliance and Quality Committee. The Chief Compliance Officer coordinates and communicates all assigned compliance activities and programs, as well as plans, implements, and monitors the compliance program. The Chief Compliance Officer ensures that L.A. Care Health Plan meets all state and federal regulatory and contractual requirements. The Chief Compliance Officer is responsible for all internal compliance and auditing activities including conducting regular internal audits to ensure appropriate financial and administrative controls are in place. The Chief Compliance Officer is responsible for developing annual compliance plans for each of L.A. Care's lines of business as well as their implementation and the regular reporting to the appropriate Board Committee and/or Board of the organization's progress in implementing those plans. The Chief Compliance Officer is also responsible for providing oversight for the delivery of health care services via subcontracts with the extensive provider network at the subcontracting health plan level as well as the direct provider level.  To this end, the Chief Compliance Officer oversees a robust department which includes compliance professionals with expertise and responsibilities for the following areas: Medicare Compliance, Special Investigations, Privacy Officer, Delegation Oversight, policies and procedures, Internal Audit, and organization-wide training on compliance activities.

Duties

Oversee and monitor all aspects of the implementation of the Compliance Program, including an annual schedule of Compliance activities. Establish an ethical, audit-ready and efficient organization. Provide organizational education and training that assures corporate compliance.

Development and implementation of internal compliance reviews and monitoring activities (including financial and operational compliance reviews).  Routine Internal Audits include, but are not limited to, the claims adjudication process, Member Rights, Internal compliance is monitored and improvements are documented. Independent authority to directly report compliance status to the Board's Compliance and Quality Committee.

Develop policies and programs that encourage management, employees and members to report any suspected fraud. Serve as team leader for the special investigation unit (SIU).

Development and implementation of external compliance reviews on subcontractors such as Plan Partners, contracted provider groups, and third party vendors. Develop internal processes to coordinate activities with all appropriate departments and functions. Development and implementation of training programs for internal staff and subcontractors such as Code of Conduct, Fraud, Waste , and Abuse, Privacy and Information Security. Assure that the organization is in compliance with all new laws, regulations and directives.

Provide leadership in coordination with others in the organization for the implementation of all Health Insurance Portability and Accountability Act (HIPAA) development activities. Proactively work with managers to improve organizational effectiveness.

Provide ongoing reporting on activities to the Chief Executive Officer, Chief of Staff and to the organization's Compliance Committee of the Board.

Manage and work in collaboration with Plan Partner Account Executive to address Plan Partner operational and strategic issues.

Perform other duties as assigned.

Duties Continued

Education Required

Education Preferred

Experience

Required:
At least 8 years of experience in managed care compliance with at least 10 years of management experience in regulatory and compliance in healthcare, insurance or related field, and in managed care compliance. 

Skills

Required:
Strong interpersonal and leadership skills with ability to interact with various departments and all levels of management.

Ability to work in a fast-paced and changing environment; reacts professionally under pressure.

Strong facilitation and mentoring skills.

Excellent written and verbal communication skills.

Ability to manage multiple priorities across multiple teams/projects, platforms.

Excellent time management skills.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information