Compliance Director

Summary

Join XO Health, a health plan designed for self-insured employers, as their Compliance Director. Lead and direct the organization's Compliance Program, ensuring adherence to state and federal regulations, licensure requirements, and NCQA/URAC standards. This pivotal role maintains legal and regulatory integrity, oversees licensure, and facilitates accreditation. You will collaborate with cross-functional teams, implement compliance policies, and monitor for potential risks. The position requires extensive experience in healthcare compliance, licensure, and accreditation, particularly with TPAs, NCQA, and URAC standards. A competitive salary and full compensation package are offered.

Requirements

• Bachelor's degree in healthcare administration, business, or a related field
• Minimum of 10 years’ experience, including 3-5 years of Compliance experience, in personnel management and compliance related activities, legislative and regulatory activities, health insurance operations or legal research or equivalent combination of education and experience
• Demonstrated knowledge and experience in healthcare compliance, licensure, and accreditation, specifically with TPAs, NCQA, and URAC standards
• Understanding of health policy issues related to healthcare activities
• Demonstrated ability to create a long-term vision and manage a team and function to that vision
• Demonstrated ability to partner effectively with others in the handling complex issues
• Strong knowledge of state and federal regulations governing TPAs and healthcare services
• Proven track record of successful URAC accreditation for TPAs
• Strong knowledge of compliance program element expectations from the DOJ, HHS OIG, and CMS
• Exceptional analytical and problem-solving skills with acute attention to detail and experience improving the resiliency of operational processes
• Excellent communication and interpersonal skills, with the ability to work collaboratively across departments
• Ability to effectively manage multiple priorities and deadlines in a dynamic environment

Responsibilities

• Monitor, interpret, and communicate changes in state and federal regulations related to TPAs
• Oversee the licensure application and renewal processes, ensuring timely submission and adherence to regulatory requirements
• Maintain a comprehensive understanding of state-specific licensing requirements and work with legal counsel to address any compliance issues
• Lead the preparation and submission of documents required for NCQA and URAC accreditation
• Coordinate internal efforts to meet NCQA and URAC standards, collaborating with various departments to implement necessary policies and procedures
• Serve as the primary contact for URAC and NCQA surveyors, facilitating site visits, interviews, and document reviews
• Develop and implement a robust compliance monitoring program to identify and address potential compliance risks
• Conduct regular internal audits and assessments to ensure adherence to licensure requirements and URAC standards
• Collaborate with operational teams to address identified compliance issues, providing guidance on process improvement, operational excellence, root cause analysis, and corrective actions
• Ensure that the Compliance Program can prevent and detect significant instances or patterns of illegal, unethical, or improper conduct by employees, brokers, providers, or others working with the organization
• Develop, update, and maintain policies and procedures related to licensure and NCQA and URAC accreditation
• Ensure that policies are aligned with regulatory requirements and industry best practices
• Educate staff on compliance policies and provide training programs as needed
• Maintain accurate and organized records related to licensure, NCQA and URAC accreditation, and compliance activities
• Prepare and submit timely reports to regulatory agencies and internal stakeholders
• Analyze compliance data to identify trends, proactively addressing potential issues
• Establish, maintain and supplement as necessary a company compliance manual
• Collaborate with legal counsel, government affairs, regulatory agencies, and external consultants to stay abreast of changes in regulations and accreditation standards
• Coordinate, as appropriate, with legal counsel, conducting, or authorizing and overseeing investigations of matters that merit investigation under the Compliance Program
• Foster positive relationships with regulatory authorities and serve as the organization's representative in compliance-related matters
• Chairs the Compliance Committee, including developing appropriate agendas, reports and information as directed by the committee

Preferred Qualifications

Certification in Healthcare Compliance (CHC), Certified in Healthcare Privacy Compliance (CHPC), Certified Internal Auditor, or other relevant certification is a plus

Benefits

• Full compensation packages are based on candidate experience and relevant certifications
• $150,000 — $175,000 USD