Milwaukee, Wisconsin
SVP of Compliance -Wisconsin Job Opening in Milwaukee, Wisconsin - Leading healthcare enterprise - excellent team work - generous relocation package.
Strong, transparent leadership team seeks a compliance executive who will continue the already successful programs and contribute to the continued growth in this market. The VP will work as a partner to the CEO and participate in meetings with a high-powered Board.
SVP will serve as a key part of the local leadership team ensuring health plan and corporate are in compliance with state and federal program regulations, insurance regulations, and regulatory requirements.
VP will have ownership of tracking laws and regulations, contract documentation, amendments, and various compliance measures. The effective development of policies, procedures, and processes to comply with state law, federal law, contract requirements, and various standards across the organization will be essential. Oversight for various compliance programs, including fraud and abuse and HIPAA will be a part of the compliance role. Provide guidance to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language. Conduct compliance audits, develop and implement corrective action plans, and report on achievement of action plans to senior management and Board of Directors. Building strategic relationships with state legislative policymakers and assisting with the development of state legislative public policy concerning state insurance, Managed Care Organization, Medicare and Medicaid regulations and initiatives. Identify, evaluate and analyze the impact of state legislative and regulatory issues and advise management concerning impact.
Ideal candidate:
Minimum of a Bachelor's degree in Public Policy, Government Affairs, Business Administration or similar field.
Masters or Law Degree is a plus
10 + years as a leader in compliance program management and contract experience along with extensive knowledge of state administrative code and regulations, state insurance laws and regulations including managed care regulations.
Experience with state and federal government agencies, accreditation bodies, participating provider agreements, HIPAA and Third Party Administration (TPA) laws, credentialing regulations and prompt pay laws
15+ years of program management and contract experience preferred.
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