Director Of Corporate Compliance - Philadelphia - Care Lync

Director Of Corporate Compliance

As Director of Corporate Compliance, you will become an integral part of the Care Lync Management team and act as a trusted advisor to and resource for Senior Leaders. The Director of Corporate Compliance will be involved in critical components of the organization including expansion and growth efforts and training and education. Above all else, the main responsibility of this role is to ensure that all day-to-day activities, workflows and policies adhere to state and program regulations

General Description

Designs and implements programs, policies, and practices to ensure that the organization complies with state, program, and accreditation standards.

Builds and maintains programs to ensure compliance with federal, state, and local regulations.

Directs the collection and analysis of data to meet compliance requirements.

Continually assess the effectiveness of departmental functioning, including the people, processes and technologies needed to remain in compliance in all states and programs in accordance to state and program policies, procedures, and bulletins. Identify problems and opportunities for improvement and generate creative solutions that improve qualitative and quantitative performance.

Assume role of Certified Investigator and Incident Management Lead for PA and additional programs and states as needed

Serve as main point of contact for all Compliance audits and investigations and manage all activities and tasks associated with audits. Ensuring timely completion. Essential to this role is the ability to track and trend emerging issues and how we may be able to respond on an organizational level.

Respond to questions and concerns relating to general corporate, state and program specific compliance rules and regulations

Create, rollout and manage regular internal audit activities across multiple states and programs focused on claim submission, policies, and procedures

Through internal audit activities, identify areas with potential compliance issues and develop work plan activities.

Track and trend corrective action plans (CAPs) related to all areas of responsibility. Ensuring CAPs are addressed and closed in a timely manner. Be able to identify systemic issues and work with the Regional Managers and Director of Corporate Training to develop solutions.

Manage ongoing relationships with State Audit contacts,

Review and confirm the accuracy of data being submitted for state audit purposes

Compile and finalize reports from areas of oversight for internal reporting purposes. Includes: Compliance Committee, Fraud, Waste and Abuse Committee, DEI, Critical Incident Committee and Audit and Compliance Committee. Work with the Regional Managers and VP of Operations to develop agenda and highlight issues that must be brought to the attention of the Committees.

Develops and/or ensures that internal controls are implemented to prevent and detect instances or patterns of illegal, unethical, or improper conduct.

Monitor key elements of Corporate, State and Program compliance and ensure supporting policies and procedures are reviewed and updated annually and as needed.

Assisting with development and implementation of training programs for members of the workforce.

Establish compliance goals for the organization, oversee staff training for new processes, and create reports on compliance updates for upper management.

Qualifications:

Minimum of at least two years' experience in a compliance related role

Bachelor's or master's degree in business administration, Law, Finance, or related discipline required

CCEP certification a plus but not required

Knowledge of regulatory frameworks

Proven track record in designing and implementing compliance programs

Excellent communication skills and attention to detail

Ability to lead and manage a team/group of people

Ability to effectively communicate with C-Suite and Executive Leadership members along with state and federal contacts.

A meticulous approach to the creation and revision of regulations and guidelines, policies, and workflows

Reside in the Philadelphia area and ability to travel to corporate office as needed.