Health Plan Contract Administrator (Hybrid in Troy, MI) - Health Alliance Plan

Business (Non-Clinical)

Plan, lead and manage the day-to-day operation of the Compliance Program with respect to Government programs compliance requirements. Responsible, under the direction of the Director-Compliance, to provide overall strategic direction to manage compliance with Government programs rules and regulations. Serve as a subject matter expert and consultant to HAP's Senior Leadership, Corporate Leadership Council members, members of various business areas, and Henry Ford Health Executives on key issues associated with compliance for Government programs.

Provide summary reports of compliance initiatives and monitoring metrics for Government programs compliance activities and report to the Corporate Compliance Committee. Act as the liaison for the Compliance department, collaborating with key departments and individuals such as Human Resources, Membership & Billing, Sales, Client Services, Legal, I.T. and the Information Security Officer to ensure policies and procedures are designed, developed, and implemented to ensure compliance with Government programs regulations.

Manage investigative activities related to Government programs compliance issues and violations including coordinating with business units and departments to monitor and assess violations, ensure timely investigations and corrective actions as well as tracking of violations for the purpose of annual reporting.

Note : Government programs compliance oversight and regulations may be specific to Medicare, Medicaid, Office of Personnel Management (OPM) the Affordable Care Act (ACA) or the Health Insurance Portability and Accountability Act (HIPAA).

Principle Duties and Responsibilities :

• Implement initiatives to raise awareness of Government programs compliance including Lead, plan, develop and conduct education and training activities related to compliance; Develop presentations for departments and individuals at all levels to provide compliance regulatory updates; Provide regular contributions to the compliance newsletter.
• Develop and / or revise policies, procedures, documents, forms, tools, job aids and training and awareness materials both organization wide and business area specific in accordance with Government programs regulations and obtain corporate approvals as necessary.
• Conduct annual risk assessment for Government programs compliance and create and execute an annual compliance auditing plan, including identifying and overseeing resolution of any management corrective action activities.
• Manage ongoing compliance monitoring and auditing and provide recommendations for corrective actions to the business areas.
• Manage relationship with government regulators at the state and national level for Government programs compliance and investigate and respond to all government agency inquiries and investigations.
• Identify and supply on a regular basis relevant metrics, compliance risk indicators and provide reports on Government programs compliance issues affecting key program initiatives.
• Review legal policy and regulations related to Government programs, translate those regulations into business and technology requirements, then provide consultative opinions, and facilitate compliance by working with various business areas and other stakeholders to lead multiple implementation efforts.
• Serve as subject matter expert to a variety of system-level initiatives (e.g., product development efforts, new sales channel implementations, provider initiatives, information technology advancements etc.) and ensure these key initiatives are taken from development to fruition in a compliant manner including recommending enhancements.
• Facilitate and manage compliance committees and workgroups with participants from across the organization supporting Government programs compliance.
• Oversee the intake, documentation, investigation, analysis and remediation of compliance violations and issues for Government programs compliance, including escalation to leadership and senior leadership as appropriate.
• Perform other duties as assigned.

Education / Experience Required :