Job Description


Monterey, CA

Full Time (Exempt)

Work Hours: Exempt

5/16/2019

Director of Compliance - Aspire Health Plan                                                                

Position Summary:  Fulfill Aspire’s compliance commitment by planning, designing, implementing and refining the Compliance Program.  This involves developing standards, coordinating compliance training and education, conducting or arranging internal audits, identifying compliance issues and trends, investigating and resolving compliance complaints and promoting awareness and understanding of the positive ethical and moral practices consistent with the mission and values of Aspire and those required by state and federal law. 

Duties & Responsibilities:

  • Demonstrate strong understanding of the health insurance industry and serve as a primary contact with CMS and the Department of Managed Health Care (DMHC) in California.
  • Maintain communication with the CMS Regional Office regarding approval of marketing materials and plan documents.
  • Maintain knowledge of Medicaid and Medicare operational processes and compliance oversight of Medicaid and Medicare contractual and statutory obligations.
  • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
  • Monitor and keep current with laws, regulations, standards and organizational guidelines.
  • Assess the need for additional training and education concerning compliance responsibilities.
  • Create Risk Assessments for government sponsored programs.
  • Arrange and coordinate internal audits for the purpose of monitoring and detecting non-compliance with applicable laws and Compliance Program requirements.
  • Enforce the standards and fully investigate possible violations.
  • If any non-compliance is detected, ensure that it is investigated, a corrective action is developed and carried out, and that compliance is achieved and sustained.
  • Prepare compliance reports to the Board of Directors and Executive Management to assure they remain generally informed of compliance issues and developments.
  • Monitor the effectiveness of the Compliance Program on a regular basis, including a comprehensive review conducted at least annually.
    Prepare annual budget for compliance activities.
  • Prepare operational plans based upon budget projections.

Education/Experience/Licensure:

  • A minimum of 5 years experience working in health care is required; 2 – 3 years management experience. 
  • Advanced college degree with a focus on law, business law, or health administration is strongly preferred. 
  • CHC (Certified in Healthcare Compliance), CIA (Certification in Internal Audit), or equivalent preferred or the ability to obtain necessary certification within 2 years. 
  • Relevant work experience may be substituted for educational requirements. 
  • A strong background in Internal Audit/Finance techniques, practices and theories. 
  • Thorough understanding of effective internal audit guidelines and reporting requirements. 
  • Knowledge of the Knox-Keene Act and its requirements is preferred. 
  • A strong background in HIPAA and Fraud, Waste and Abuse practices and regulations. 
  • Knowledge of CMS Medicare Advantage, contract experience with Medicaid/Medicare programs, Part D guidelines and reporting requirements. 
  • Ability to collaborate with all levels of management and staff. 
  • Able to perform analytical analysis. 
  • Able to successfully manage multiple priorities and assignments. 
  • Outstanding communication skills, both written and verbal; interpersonal skills in relating with others. 
  • Excellent skills in using Microsoft Office products including Access, Word, Excel and Outlook are required.

About Aspire: Aspire Health Plan is a locally owned Medicare Advantage HMO that provides comprehensive medical coverage to seniors and other Medicare recipients in Monterey County. We’re proud to be a community-centered organization backed by Community Hospital of the Monterey Peninsula and Salinas Valley Memorial Hospital. Over 700 doctors, many other healthcare providers, and all four Monterey County hospitals are part of the Aspire Health Plan network. It’s the care you need from people you know.

 

Aspire Health is an equal opportunity employer.

Application Instructions

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