Health Care/Attorney/In House/Las Vegas, Nevada
Location: Las Vegas, Nevada
Description: GCC Consulting is currently interviewing Health Care/Attorney/In House/Las Vegas, Nevada right now, this position will be reside in Nevada. More complete informations about this position opportunity please give attention to these descriptions. Director Compliance Officer - Plan Duties: Establish scope of activities required to support the Compliance Effectiveness ! Review at the Plan Compliance Officer (PCO) level. Lead and assure compliance training activities are completed in an effective manner. Monitor health Plan Performance Standards for compliance with contractual and regulatory requirements and maintain a general focus on call center metrics, claims payments, minimum net worth and licensure of health plans and employed professional. Maintain relevant Plan Policies and Procedures that may impact the Plan or Company and provide assessments to critical stakeholders and Plan senior leadership on consistency with regulatory and contractual requirements including anti-kickback statutes, timeliness of enrollment; and incentive compensation. Review policies and procedures and health plan activities to ensure adherence to Business Associate requirements and physical and electronic security under HIPAA. Ensure regular meetings of the Plan Compliance Committee (PCC) to discuss identification and assessment of compliance initiatives, pote! ntial risks and current state. Serve as liaison to external an! d internal audits between business owner and state/federal entities: Coordinate with OBE on preliminary investigations of potential non-compliance; maintain confidentiality as appropriate and recommend corrective action or next steps to OBE and business owners; Monitor payments or contributions to providers and community and faith based organizations made by or on behalf of the health plan to ensure compliance with company s policies and procedures including but not limited to charitable donations and gifts; Maintain a quarterly log of marketing materials reviewed via CMAP, submitted to the governing agency and approved for use and perform monthly reviews of marketing field activities to ensure compliance; Monitor and evaluate member access through review of changes in network composition and appointment guideline surveys; and verify control process used to ensure accuracy of information submitted to government agencies. Establish schedule to monitor corrective actions rela! ted to issues identified at the PCC level. Attend and participate in meetings where business strategy is discussed with Plan senior leadership. Provide regular and ad hoc reports on activities outlined above for review by the OBE and health plan CEO/EVP. Other Duties as assigned.
Requirements: A Bachelor s degree from an accredited university. Master s or higher degree in Law, Business, Healthcare will be considered. 7+ years relevant experience in healthcare compliance, audit or compliance, with 3+ years of leadership/management experience. Experience in conducting or responding to government audits and investigations, and/or direct experience working in a relevant federal agency(HHS, OIG, CMS) a plus. Proficient in the use of MS Office (Visio, Excel, Access, Word).
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If you were eligible to this position, please deliver us your resume, with salary requirements and a resume to GCC Consulting.
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This position starts available on: Sun, 21 Jul 2013 04:35:31 GMT
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