Medicare Advantage Compliance Director

6 days ago


Columbus, Ohio, United States The French Group Full time

Job Summary:

The French Group is seeking a seasoned Compliance Executive Leader to build and lead the Compliance division within our growing Medicare Advantage health plan. As a key member of our Executive Leadership team, you will be responsible for the strategic growth, oversight, and operational leadership of our Compliance program.

Key Responsibilities:

  • Implement and continually refine the Compliance Program, developing and maintaining compliance-monitoring tools as regulatory/contractual obligations change.
  • Oversee and maintain compliance with contractual and regulatory obligations, as well as State and Federal requirements.
  • Develop strategic relationships with government agencies, serving as a primary liaison for all matters related to compliance, including audits.
  • Ensure compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation.
  • Develop internal audit plans, conduct and document internal audits, and identify areas of non-compliance.
  • Establish a culture of compliance throughout the organization, developing training and education programs.
  • Manage external regulatory audits, organizing, documenting, and participating in all external audits.
  • Develop, implement, and document a master compliance auditing log, disseminating written policies and procedures related to compliance activities.
  • Communicate audit progress and findings to executive leadership and the Board of Directors.

Requirements:

  • Bachelor's degree required, Master's degree and/or Law degree preferred.
  • 8+ years of experience in managed care with Medicare regulatory compliance experience, plus a minimum of 3 years in a senior management position.
  • ISNP experience strongly preferred.


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