Experience Inc. Jobs

Director Compliance - HYBRID

Location: Philadelphia, PA

Primary Job Function: Compliance

ID**: 31541

Job Brief

This position is a HYBRID position located in our Airport Business Center - Philadelphia, PA.

Your career starts now. We are looking for the next generation of health care leaders.

At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to connect with you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Responsibilities:

The Director, Compliance reports directly to the Director, Regional Compliance and establishes and maintains strong dotted line reporting to the Pennsylvania Market President(s). The Director, Compliance provides strategic direction and leadership for the development and implementation of compliance policy, process, and control activities. He/she is responsible for the development and implementation of the Plan Compliance and Privacy Program(s) consistent with the seven elements of an effective compliance program as defined by by 42 CFR 439.608(b). Must ensure that local compliance related issues and risks are identified, aggregated, and reported.

The Director, Compliance, manages the state contract amendment process, facilitating timely review and comments and maintains appropriate change control procedures.

The Director, Compliance oversees the management of fraud, waste and abuse (FWA) compliance activities and directly manages internal and external Corrective Action Plan (CAP) processes when necessary to address issues with provider, vendor and/or subcontractor performance related to FWA.

The Director, Compliance manages Privacy investigations and other plan related privacy activities. The Director, Compliance may manage and support the development of a team of highly skilled and knowledgeable associates. Must be able to work independently with minimal management oversight and be able to manage competing priorities and deadlines that are subject to frequent change. Must possess and exercise excellent professional judgment in all interactions.

In addition, must possess the following attributes:

• Demonstrates a solid understanding of operational processes and controls and monitors the execution of operational changes required by regulations and guidelines.

• Aligns and monitors compliance training and education programs.

• Collaborates and assists in the development and implementation of the annual enterprise compliance plans.

Pennsylvania Director, Compliance Additional Responsibilities:

The Director, Compliance oversees the relationship with the DHS Bureau of Program Integrity (BPI) , as it pertains to BPI initiated provider retrospective reviews and other FWA activities.

The Director, Compliance, provides strategic guidance to the implementation of policy and initiatives in response to emerging federal and state health care policy. He/she actively participates in Coalition discussions and activities.

The Director, Compliance oversees PA plan compliance with the requirements of the delegated relationship with Independence Blue Cross via reporting of privacy incidents and sharing of CAP-related information.

Education/Experience:

• Bachelor’s Degree required.

• Certified in Health Care Compliance (CHC) preferred.

• 5+ years management experience in managed healthcare environment, including experience in the areas of compliance oversight.

• Demonstrated knowledge of compliance concepts and practices (strategies, control activities, information analysis and reporting and communication).

• Strong facilitation, collaboration and teamwork skills with the ability to build cross-functional partnerships to drive results.

• Strong interpersonal skills.

Diversity, Equity, and Inclusion

At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

EOE Minorities/Females/Protected Veterans/Disabled