Compliance Director

Compliance Director

Location: Birmingham, AL

Work Schedule: This position is based in the VIVA HEALTH corporate headquarters in downtown Birmingham and has some work-from-home opportunities.  The individual in this role must reside within driving distance of downtown Birmingham.

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has consistently been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

Benefits

• Comprehensive Health, Vision, and Dental Coverage
• 401(k) Savings Plan with company match and immediate vesting
• Paid Time Off (PTO)
• 9 Paid Holidays annually plus a Floating Holiday to use as you choose
• Tuition Assistance
• Flexible Spending Accounts
• Healthcare Reimbursement Account
• Paid Parental Leave
• Community Service Time Off
• Life Insurance and Disability Coverage
• Employee Wellness Program
• Training and Development Programs to develop new skills and reach career goals
• Employee Assistance Program

See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits

Job Description

The Compliance Director is the Compliance Officer responsible for ensuring the Company’s compliance with state and federal laws and regulations. This role ensures compliance with Centers for Medicare & Medicaid Services (CMS) and Department of Insurance (DOI) regulations; fraud, waste and abuse (FWA); and ensures proper review, dissemination, and implementation of new or revised requirements.

This individual supervises the Manager of Compliance, Compliance Auditor, and Statutory Compliance Accountant. This position serves as the Chief Audit Executive for coordinating and conducting internal audits; also serves as the Civil Rights Grievance Coordinator.

Key Responsibilities

• Collaborate with management to ensure Medicare Part C and D compliance. This includes but is not limited to serving as the primary point of contact for the CMS Plan Manager, communicating CMS requirements, maintaining documentation to demonstrate the Plan’s compliance, conducting mock CMS audits, assisting in the development of policies and procedures, collecting supporting documentation, and identifying and addressing areas of non-compliance.
• Collect and submit Part C and D required reporting information to CMS in accordance with established deadlines. Monitor CMS reports to identify areas for improvement and work with the departments involved to improve scores. Coordinate external audit of measures.
• Coordinate CMS and DOI audit and oversight activities by ensuring required information is submitted within established timeframes and any resulting observations, findings, or corrective action plans are adequately addressed.
• Chair the Compliance Committee and oversee the implementation and on-going maintenance of the compliance plan and the related compliance policies.
• Maintain procedures for staff to report any improprieties, regardless of severity, without fear of retaliation in any form. Investigate compliance matters and prepare reports for the CEO, Board of Directors and Audit Committee on compliance related activities.
• Maintain relationships with state and federal regulators and stay abreast of regulatory changes.
• Coordinate and conduct internal audits to verify compliance with regulatory and accounting standards. Ensure corrective action is taken as needed to correct any negative findings. Report audit results and findings regularly to Senior Management and the Board of Directors.

REQUIRED:

• Bachelor’s degree 
• At least 7 years of experience with health care compliance
• 5 years' management experience
• Knowledge of applicable state and federal regulations including CMS requirements
• Demonstrate excellent verbal and written communication skills including ability to draft policies and procedures and to respond to regulatory inquiries in a professional manner
• Proficient in Microsoft Office suite of products
• Ability to travel to meetings, delegated entities, and other locations including conferences in other cities as needed 

PREFERRED:

• Master’s Degree or Law Degree
• Managed Care experience
• Medicare Part C and D experience
• CPA
• Knowledge of applicable state and federal regulations for Medicare Advantage plans including Part C and Part D as well as Special Needs Plan (SNP) requirements