Healthcare administration serp_jobs.h1.location_city

NationsBenefits is recognized as one of the fastest-growing companies in America and a Healthcare Fintech provider of supplemental benefits, flex cards, and member engagement solutions. We partner with managed care organizations to provide innovative healthcare solutions that drive growth, improve outcomes, reduce costs, and bring value to their members.

Through our comprehensive suite of innovative supplemental benefits, fintech payment platforms, and member engagement solutions, we help health plans deliver high-quality benefits to their members that address the social determinants of health and improve member health outcomes and satisfaction.

Our compliance-focused infrastructure, proprietary technology systems, and premier service delivery model allow our health plan partners to deliver high-quality, value-based care to millions of members.

We offer a fulfilling work environment that attracts top talent and encourages all associates to contribute to delivering premier service to internal and external customers alike. Our goal is to transform the healthcare industry for the better! We provide career advancement opportunities from within the organization across multiple locations in the US, South America, and India.

OVERVIEW

This executive leader ensures that all policies, procedures, and business activities align with regulatory requirements, including AML, HIPAA, OFAC, FWA, and CMS regulations; the role requires deep expertise in healthcare compliance, risk management, and regulatory affairs to mitigate compliance risks and foster a strong culture of ethics and integrity throughout the organization. The VP of Healthcare and Compliance will work closely with executive leadership, legal teams, and operational departments to maintain a robust compliance program that supports business objectives while ensuring regulatory adherence.

PRIMARY RESPONSIBILIES

• Lead the development, implementation, and monitoring of compliance policies, procedures, and programs to ensure alignment with CMS, HIPAA, OIG, HHS, OFAC, AML, and FWA requirements.
• Oversee compliance audits, internal investigations, and risk assessments to proactively identify and address compliance concerns.
• Ensure compliance with state and federal laws governing healthcare operations and managed care contracts.
• Promote a culture of compliance and ethical business practices across all levels of the organization.
• Provide guidance and training to employees, executives, and board members on compliance policies and evolving regulations.
• Develop and oversee the corporate compliance program, ensuring a strong internal reporting mechanism for compliance concerns.
• Lead fraud, waste, and abuse (FWA) prevention initiatives, ensuring adherence to federal and state fraud-prevention standards.
• Work with legal counsel and external consultants to investigate and resolve compliance violations.
• Ensure ongoing monitoring of contracts, claims, and financial transactions to identify and mitigate fraud risks.
• Oversee Medicare and Medicaid compliance requirements for contracts with managed care organizations.
• Ensure accurate reporting and documentation in compliance with CMS guidelines.
• Monitor regulatory changes and recommend policy updates to maintain compliance with Medicare Advantage (MA) and Medicaid Managed Care requirements.
• Advise the CEO, board of directors, and senior leadership on compliance risks and strategic regulatory decisions.
• Develop and maintain a comprehensive compliance strategy that aligns with business goals while ensuring regulatory adherence.
• Collaborate with cross-functional teams (legal, finance, HR, and operations) to integrate compliance into all business processes.

SKILL REQUIREMENTS

QUALIFICATIONS AND EDUCATION REQUIREMENTS

NationsBenefits is an Equal Opportunity Employer .