Description

Summary:

This role performs audits to ensure the organization is in compliance with federal, state and Association regulatory requirements (Centers for Medicare and Medicaid Services, Department of Health, Department of Financial Services, Department of Labor, Blue Cross Blue Shield Association, Federal Employee Plan, Office of Inspector General, Office of Medicaid Inspector General). The Administrator provides collaborative oversight and management of regulatory requirements to achieve optimal compliance performance to meet corporate goals. The incumbent will support risk mitigation by assessing regulatory compliance through various methods including auditing and monitoring, conducting root-cause analysis, identifying best practice opportunities, and making recommendations for process improvement or refinement activities.

Essential Accountabilities:

Level I

•\tResearches, interprets, and communicates regulatory requirements to internal customers. Prepares business areas and all levels of personnel for upcoming external audits, including but not limited to reference materials, audit basics, expectations, coordinating and facilitating education sessions, etc.

•\tAssesses potential non-compliance vulnerabilities and identifies root causes of issues. Collaborates with business area ambassadors to develop recommendations and reach meaningful and appropriate resolutions.

•\tIndependently facilitates, establishes, manages, and monitors work teams to successfully conduct internal and external audits and surveys. Plans, performs fieldwork, reports and follows up on specific audit assignments.

•\tFacilitates and provides guidance on corrective action responses to examination findings and collaborates with Compliance to ensure appropriate processes and controls are documented to address risks and deficiencies.

•\tActs as the single point of contact for State and Federal examiners to ensure any questions are addressed and the requirements are understood by all stakeholders.

•\tDevelops and manages risk assessments including data collection, integrity testing, and routine reporting across the corporation.

•\tDevelops, maintains, and analyzes various reporting sources including those related to regulatory commitments, Ad Hoc Corporate issues and all general Regulatory compliance issues.

•\tInitiates and executes long and short-range planning processes and identifies and schedules resources required to meet audit plans, deliverables, and objectives.

•\tEffectively leads and manages assigned Regulatory Compliance initiatives and projects.

•\tConsistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.

•\tMaintains high regard for member privacy in accordance with the corporate privacy policies and procedures.

•\tRegular and reliable attendance is expected and required.

•\tPerforms other functions as assigned by management.

Level II (in addition to Level I Accountabilities)

•\tActs as a cross-functional resource to operational areas regarding regulatory compliance matters.

•\tPerforms audits across multiple lines of business.

•\tMay oversee audits performed by external vendors and regulatory agencies.

•\tServes as a mentor and shares acquired knowledge and expertise to help others learn and grow.

Level III (in addition to Level II Accountabilities)

•\tManages the highest level of complex regulatory compliance issues and exercises decision-making in cross-functional work groups.

•\tFacilitates audits conducted by regulatory agencies.

•\tProvides guidance to less experienced team members and internal customers in the absence of management. Acts as a resource for the department and serves as a trusted advisor to the organization.

Minimum Qualifications:

NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.

Level I

•\tNine or more years' experience in health insurance or health care delivery, or Bachelor's degree in related area with five or more years of related experience or compliance training.

•\tExtensive knowledge of regulatory initiatives and legislation that impacts the Health Insurance Industry.

•\tDemonstrated ability to understand regulations and administer compliance for all areas across an organization.

•\tStrong analytical and organizational skills and ability to manage multiple projects and systems simultaneously with minimal management directive. Ability to effect change efficiently and smoothly.

•\tDemonstrated experience in taking ownership of issues and follow through to resolve them promptly and accurately.

•\tExceptional verbal and written communication skills and ability to collaborate across the organization.

Level II (in addition to Level I Qualifications)

•\tNine or more years in health insurance or health care delivery or Bachelor's degree in related area with seven or more years of related experience or training.

•\tProgression toward Certified Internal Auditor (CIA) certification desirable.

•\tAbility to independently perform regulatory audits across multiple lines of business.

Level III (in addition to Level II Qualifications)

•\tTwelve or more years in health insurance or health care delivery or Bachelor's degree in related area with ten or more years of related experience or training.

•\tCertified Internal Auditor (CIA) certification preferred.

•\tDemonstrated abilities in handling the highest level of complex compliance issues.

•\tHighly innovative with ability to work autonomously with limited guidance.

Physical Requirements:

•\tAbility to work prolonged periods sitting and/or standing at a workstation and working on a computer.

•\tAbility to travel across the Health Plan service region for meetings and/or trainings as needed.

•\tAbility to read extensively and perform analysis.

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In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

Level II (E4): Minimum: $65,346 - Maximum: $117,622

Level III (E6): Minimum: $79,068 - Maximum: $142,322

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.