Analyze and interpret contractual, state and federal regulatory, and accreditation requirements.
Participate in and conduct compliance functions, including, but not limited to, developing compliance tools and validating implementation of new requirements and corrective action plans.
Work with internal business units to prepare reports for distribution to internal Committees and external entities.
Facilitate cross-functional teams including internal business units and/or external entities to correct performance deficiencies.
Prepare and conduct trainings for internal business units and/or external entities.
Review, approve and suggest revisions on policies and procedures, member/provider materials, compliance work plans, etc., as well as submit to regulatory entities for approval.
Work with internal business units to identify gaps, develop and implement corrective action plans and facilitate monitoring activities to ensure compliance with regulatory requirements.
Review internal and external inquiries and collaborate with all levels of organizational management, business units and our Delegates to ensure timely, accurate, and complete submissions. This includes self-disclosures of non-compliance issues to the regulators.
Develop, maintain, and monitor Internal Compliance Committee (ICC) Charter, Compliance Program and key performance indicators. Responsible for the development of Board/committee write-ups to be presented at the Compliance & Quality (C&Q) and Internal Compliance Committee (ICC) meetings.
Perform other duties as assigned.