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Government Programs Compliance Officer (Director)
Jacksonville, FL
Job Description
Are you interested in joining a team of experienced healthcare experts and have the ability to shape and transform the healthcare delivery system? At our family of companies, everything we do is to help improve the lives of the nearly 12 million Medicare beneficiaries we serve and 700,000 health care providers who care for them. It is our goal to help create a better health experience for all consumers. Join our winning culture and help transform Medicare for the millions of people who rely on its services.
Benefits info:
* Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire
* Short- and long-term disability benefits
* 401(k) plan with company match and immediate vesting
* Free telehealth benefits
* Free gym memberships
* Employee Incentive Plan
* Employee Assistance Program
* Rewards and Recognition Programs
* Paid Time Off and Paid Sick Leave
* Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire
* Short- and long-term disability benefits
* 401(k) plan with company match and immediate vesting
* Free telehealth benefits
* Free gym memberships
* Employee Incentive Plan
* Employee Assistance Program
* Rewards and Recognition Programs
* Paid Time Off and Paid Sick Leave
SUMMARY STATEMENT
The Government Programs Compliance Officer is responsible for overseeing the Navigator Compliance and Ethics Program (Navigator Program), for Novitas Solutions, Inc. (Novitas) and First Coast Service Options, Inc. ("First Coast") (collectively "the Companies") which includes ensuring the recognized elements of an effective ethics and compliance program are in place to establish a culture that promotes the prevention, detection and resolution of instances of conduct that do not conform to federal and state law, or to government program requirements. The Compliance Officer reports directly to the Board of Directors' Audit and Compliance Committees, with an administrative reporting relationship to the Chief Compliance Officer.
The Government Programs Compliance Officer is responsible for overseeing the Navigator Compliance and Ethics Program (Navigator Program), for Novitas Solutions, Inc. (Novitas) and First Coast Service Options, Inc. ("First Coast") (collectively "the Companies") which includes ensuring the recognized elements of an effective ethics and compliance program are in place to establish a culture that promotes the prevention, detection and resolution of instances of conduct that do not conform to federal and state law, or to government program requirements. The Compliance Officer reports directly to the Board of Directors' Audit and Compliance Committees, with an administrative reporting relationship to the Chief Compliance Officer.
ESSENTIAL DUTIES & RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.
ORGANIZATION (30%)
* Model integrity and respect and be approachable by team members and management at all levels of the company.
* Lead the Companies' Navigator Program for all applicable contracts.
* Lead the Compliance oversight function that supports the Medicare Fee-For-Service contracts (Medicare FFS), and other Medicare lines of business.
* Present periodic reports and evaluation of the Navigator Program to the Audit and Compliance Committee of the Board of Directors describing the nature and number of inquiries and allegations received, the progress of the Navigator Program toward meeting and exceeding its established goals and objectives.
* Chair the Executive Compliance Committee (ECC), including establishing the ECC Charter, developing appropriate agendas, reports, and information.
* Take necessary action to stop or prevent the submission of data or reports to the government or other external agencies that he/she believes contain material errors.
* Oversee Company's annual Conflict of Interest disclosure process and preparation of the Conflict of Interest document submissions to government customers and address all conflict of interest questions regarding the current contracts, subcontracts and potential business (RFI/RFP). If necessary, develop organizational conflict of interest mitigation plans to address any actual, potential or apparent conflict associated with the current and potential contracts, and make findings and disclosures as appropriate.
* Lead the Companies' Navigator Program for all applicable contracts.
* Lead the Compliance oversight function that supports the Medicare Fee-For-Service contracts (Medicare FFS), and other Medicare lines of business.
* Present periodic reports and evaluation of the Navigator Program to the Audit and Compliance Committee of the Board of Directors describing the nature and number of inquiries and allegations received, the progress of the Navigator Program toward meeting and exceeding its established goals and objectives.
* Chair the Executive Compliance Committee (ECC), including establishing the ECC Charter, developing appropriate agendas, reports, and information.
* Take necessary action to stop or prevent the submission of data or reports to the government or other external agencies that he/she believes contain material errors.
* Oversee Company's annual Conflict of Interest disclosure process and preparation of the Conflict of Interest document submissions to government customers and address all conflict of interest questions regarding the current contracts, subcontracts and potential business (RFI/RFP). If necessary, develop organizational conflict of interest mitigation plans to address any actual, potential or apparent conflict associated with the current and potential contracts, and make findings and disclosures as appropriate.
COMMUNICATION AND TRAINING (25%)
* Communicate the importance of ethics and compliance policies and standards of the Navigator Program to team members, management, the Executive Compliance Committee, and the Audit and Compliance Committee of the Board of Directors, including promoting (1) use of the compliance helpline, (2) increased awareness of the Navigator Program, and (3) understanding important compliance issues and related policies and procedures.
* Collaborate with and assist management and team members with understanding and complying with regulatory requirements. This includes researching regulations and assisting as needed in developing procedures to comply.
* Develop and/or implement education programs addressing ethics and compliance for team members.
* Develop and maintain productive relationships with all levels of management as well as government customer representatives, and other relevant external parties.
* Work with operational leadership to provide adequate information to ensure that they and their employees have the requisite information and knowledge of regulatory issues and requirements to carry out their responsibilities in a lawful and ethical manner.
* Collaborate with and assist management and team members with understanding and complying with regulatory requirements. This includes researching regulations and assisting as needed in developing procedures to comply.
* Develop and/or implement education programs addressing ethics and compliance for team members.
* Develop and maintain productive relationships with all levels of management as well as government customer representatives, and other relevant external parties.
* Work with operational leadership to provide adequate information to ensure that they and their employees have the requisite information and knowledge of regulatory issues and requirements to carry out their responsibilities in a lawful and ethical manner.
POLICIES, PROCEDURES AND STANDARDS (20%)
* Develop and manage the annual Compliance Work Plan.
* Participate as a member of the Policy Governance Committee.
* Develop and implement procedures and practices designed to promote compliance with the requirements set forth in the requirements of government programs, specifically including the Medicare and Medicaid Program requirements.
* Participate as a member of the Policy Governance Committee.
* Develop and implement procedures and practices designed to promote compliance with the requirements set forth in the requirements of government programs, specifically including the Medicare and Medicaid Program requirements.
MONITORING, AUDITING AND ENFORCEMENT (25%)
* Monitor the performance of the Companies' Navigator Program on an ongoing basis, taking appropriate steps to improve its effectiveness.
* Conduct investigations of alleged misconduct and make findings and disclosures as appropriate.
* Coordinate investigations with Legal, Information Security and Privacy, Internal Audit and others as appropriate.
* Respond appropriately internally and externally if a violation is uncovered.
* Track all issues reported or referred to the Compliance Office, up to and including resolution.
* Collaborate with the Director of Internal Audit on the performance of independent audit/appraisals of corporate processes and internal controls.
* Coordinate with internal audit, as necessary, to prospectively test compliance with CMS Control Objectives and applicable laws and regulations.
* Participate in the annual risk assessment process and the Certification Package for Internal Controls (CPIC) process.
* Monitor compliance with laws, rules, and regulations applicable to government programs, specifically including the Medicare and Medicaid Program requirements, as well as company policies.
* Provide input and/or direction to the team member performance appraisal and incentive programs to ensure improper conduct is reported and discouraged and that support of and conformity with the Navigator Program is part of any performance evaluation process for all employees.
* Collaborate with HR to determine appropriate corrective actions for team members for violations of the Navigator Program.
* Conduct investigations of alleged misconduct and make findings and disclosures as appropriate.
* Coordinate investigations with Legal, Information Security and Privacy, Internal Audit and others as appropriate.
* Respond appropriately internally and externally if a violation is uncovered.
* Track all issues reported or referred to the Compliance Office, up to and including resolution.
* Collaborate with the Director of Internal Audit on the performance of independent audit/appraisals of corporate processes and internal controls.
* Coordinate with internal audit, as necessary, to prospectively test compliance with CMS Control Objectives and applicable laws and regulations.
* Participate in the annual risk assessment process and the Certification Package for Internal Controls (CPIC) process.
* Monitor compliance with laws, rules, and regulations applicable to government programs, specifically including the Medicare and Medicaid Program requirements, as well as company policies.
* Provide input and/or direction to the team member performance appraisal and incentive programs to ensure improper conduct is reported and discouraged and that support of and conformity with the Navigator Program is part of any performance evaluation process for all employees.
* Collaborate with HR to determine appropriate corrective actions for team members for violations of the Navigator Program.
Performs other duties as the supervisor may, from time to time, deem necessary.
REQUIRED QUALIFICATIONS
* Bachelor's degree and seven plus (7+) years related experience.
* Working knowledge of the essential elements of an effective compliance program as outlined in the U.S. Sentencing Commission guidelines.
* Ability to read, analyze and interpret policies, technical procedures, government contract requirements, governmental regulations and legal documents.
* High integrity.
* Proactive.
* Approachable by employees and management at all levels of the organization.
* Excellent organizational and analytical skills. Ability to work well both independently and with others in a matrix environment.
* Excellent judgment.
* Strong influencing skills and perseverance in investigating.
* Excellent oral and written communication skills.
* Ability to write clear, concise reports, business correspondence, and procedures.
* Ability to effectively present and represent Company's interests externally with CMS representatives.
* Ability to effectively present information and respond to inquiries from employees, CMS, and others, as necessary.
* Bachelor's degree and seven plus (7+) years related experience.
* Working knowledge of the essential elements of an effective compliance program as outlined in the U.S. Sentencing Commission guidelines.
* Ability to read, analyze and interpret policies, technical procedures, government contract requirements, governmental regulations and legal documents.
* High integrity.
* Proactive.
* Approachable by employees and management at all levels of the organization.
* Excellent organizational and analytical skills. Ability to work well both independently and with others in a matrix environment.
* Excellent judgment.
* Strong influencing skills and perseverance in investigating.
* Excellent oral and written communication skills.
* Ability to write clear, concise reports, business correspondence, and procedures.
* Ability to effectively present and represent Company's interests externally with CMS representatives.
* Ability to effectively present information and respond to inquiries from employees, CMS, and others, as necessary.
PREFERRED QUALIFICATIONS
* Law Degree
* Compliance related certification (e.g., Certified Compliance Professional)
* Law Degree
* Compliance related certification (e.g., Certified Compliance Professional)
This opportunity is open to in-office and hybrid remote work in or near the following approved locations: Jacksonville, FL or Mechanicsburg, PA.Specific counties and cities within these states may require further approval.
The Federal Government and the Centers for Medicare & Medicaid Services (CMS) may require applicants to have lived in the United States for a minimum of three (3) years out of the last five (5) years to be employed with the Company. These years of residence do not have to be consecutive.
"We are an Equal Opportunity Employer/Protected Veteran/Disabled"
GuideWell Source is an Equal Opportunity Employer - Protected Veteran/Disabled
Job Summary
Company
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
Bachelor's Degree
Required Experience
7 years
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