Compliance Director

2 weeks ago


Honolulu, Hawaii, United States AlohaCare Full time
About the Role

AlohaCare is seeking a highly skilled Compliance Director to promote a culture of compliance, ethics, and integrity within our organization.

Key Responsibilities
  • Compliance Program Management: Direct and manage Compliance programs, policies, and practices to ensure all business units are in compliance with Medicaid and Medicare policy and reporting regulations.
  • Regulatory Interpretation: Assist with interpretation of federal and state rules, laws, and regulations.
  • Compliance Issue Resolution: Identify and resolve compliance-related issues.
  • Compliance Work Plans: Develop and implement compliance work plans, policies, and procedures, and activities.
  • Monitoring and Auditing: Monitor and audit division and/or department functions against regulatory requirements.
  • Staff Education: Educate staff on compliance and regulations.
  • Stakeholder Communication: Communicate to staff and key external stakeholders compliance issues or regulatory and/or legislative changes.
Primary Duties and Responsibilities
  • Compliance Program Operations: Manage the day-to-day operations of the organization's corporate compliance program and plan.
  • Risk Assessments: Lead enterprise-wide risk assessments and develop auditing and monitoring plans.
  • Regulatory Audits: Coordinate and respond to regulatory audits and inquiries.
  • Liaison with State Departments: Act as a liaison with State departments to obtain regulatory approval of all policy documents.
  • Compliance Workplan Development: Assist with the development and management of the Compliance Workplan.
  • Compliance Communications: Lead development and deployment of Compliance communications and education.
  • Policies and Procedures: Ensure policies and procedures are reviewed for compliance with program regulations, insurance regulations, and regulatory requirements.
  • Contractual Agreements: Maintain a database of contractual agreements, HIPAA business associate agreements, and associated documents.
  • Regulatory Compliance Reports: Develop Regulatory Compliance reports and provide information to the board of directors and executive management as necessary and appropriate.
Required Competencies and Qualifications
  • Education: Bachelor's Degree.
  • Experience: Minimum of 4 years managerial/leadership position experience.
  • Healthcare Experience: 3-5 years of experience in health plan operations.
  • Medicare and Medicaid Experience: Experience with Medicare and Medicaid programs required or equivalent experience.
  • Compliance Program Management: Knowledge of managing an effective compliance program.
  • Communication Skills: Strong written, verbal, and presentation skills.
  • Independence and Self-Management: Ability to work independently and manage own work assignments with minimal supervision.
  • Technical Skills: Working knowledge of Microsoft Excel, Word, and PowerPoint.
Preferred Qualifications
  • Juris Doctor Degree: Juris Doctor Degree.
Physical Demands and Working Conditions
  • Computer Workstation: Requires operation of computer workstation, including keyboard and video display terminal.
  • Sedentary Work: Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects.


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