The CCS Companies is hiring a
VP Compliance Privacy Delegation

Summary

Join ComplexCare Solutions as Vice President, Compliance, Privacy and Delegation, leading enterprise-wide compliance functions, managing a multi-disciplinary team, and ensuring compliance with state regulatory requirements.

Requirements

• Minimum of twelve (10) years of prior compliance experience which may include risk assessment and audit experience
• Minimum of seven (7) years of prior experience managing teams and direct reports
• Working knowledge of key laws and regulations that apply to provider compliance, including, but not limited to, Anti-Kickback Statute, Conflicts of Interest, and Medicare and Medicaid program requirements
• Prior work experience in the healthcare industry is preferred
• Experience with monitoring and ensuring compliance with state regulatory requirements and experience in interpreting state and federal laws
• Knowledge and direct experience with CMS compliance program requirements
• Knowledge of state and federal regulatory bodies such as CMS and NCQA
• Regulatory compliance experience and health care compliance programs experience strongly preferred
• Compliance experience in risk adjustment is a plus
• Must excel in fast-paced environment with a broad set of diverse stakeholders
• Highly professional demeanor, communication style and approach, analytical and critical decision-making, investigational skills
• Effective verbal and written communication skills and interpersonal skills with the ability to effectively listen and communicate to varied levels
• Strong problem solving, risk analysis, and project management skills and the ability to work with minimal supervision
• Professionally skilled in personal presentation, verbal, and written communication
• Bachelor’s Degree or equivalent work experience required; and
• Compliance related certification preferred

Responsibilities

• Serve as the Company’s subject matter expert for compliance, privacy and risk management functions
• Function as the Company’s primary compliance point of contact both internally and externally to effectively represent Company interests and demonstrate compliance effectiveness
• Manage a multi-disciplinary compliance team that performs a variety of day-to-day delegation and compliance functions such as client audit responses, management of attestations, complaint management, internal monitoring and audit activities
• Lead compliance activities associated with state regulatory requirements and physician professional corporation operations
• Lead and conduct risk assessments and ensures implementation of training programs and compliance workplan
• Direct and manage the Company’s privacy/HIPAA program intended to achieve compliance with HIPAA and other relevant privacy laws
• Review of the compliance and regulatory aspects of client and vendor contracts to ensure that Company interests and regulatory requirements are properly addressed
• Develop and lead vendor compliance program for purchased products and services
• Oversee and investigate compliance and privacy incidents/Hotline reports and implement resolution strategies
• Oversee the enterprise-wide provider credentialing functioning
• Direct and lead the delegation function which includes managing policy reviews, leadership of all delegation oversight functions; ensuring that delegates are meeting contractual obligations; and, assuring compliance with Centers for Medicare and Medicaid Services (CMS) regulations, National Committee for Quality Assurance (NCQA) standards and other relevant guidance
• Oversee the coordination and implementation of client corrective action plans for compliance, regulatory and delegated areas
• Represent Complex Care Solutions on client calls and other audit, delegation and credentialing meetings
• Maintain compliance with Complex Care Solutions’ policies, procedures and mission statement
• Adhere to all confidentiality and HIPAA requirements as outlined within Complex Care Solutions’ Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position
• Fulfill those responsibilities and/or duties that may be reasonably provided by Complex Care Solutions’ for the purpose of achieving operational and financial success of the Company; and
• Other duties as assigned