HireDiversity

Description:


GENERAL SUMMARY



Oversees department, health plan, or assigned region to ensure compliance with state and federal laws and regulations. May act as primary liaison with CMS, the Department of Insurance, and/or the Department of Labor. Provides summaries of new legislation and develops plans for compliance.

ESSENTIAL RESPONSIBILITIES

- Responsible for overall regulatory compliance for department, health plan or assigned region.
- Oversees process for changes to standard forms, marketing materials, advertising and contracts, including, but limited to, Evidence of Coverage, Schedules of Benefits, enrollment forms, provider contracts, and group applications. Creates new documents as needed. Files new and revised documents for Department of Insurance and CMS.
- Implements tracking mechanism for all issues outstanding with state and federal regulatory entities.
- Tracks legislative issues and regulatory changes and analyzes impact on the department, health plan or assigned region. Coordinates with state trade associations and other industry groups. Develops new procedures required as the result of newly effective regulatory requirements of changes to existing health plan policies.
- Responsible for all regulatory filings for government programs with department, health plan, or assigned region.
- Oversees Market Conduct process and CMS biannual monitoring visits, including pre-exam/visit preparation, actual exams/visits, mock exams/visits, responses to draft audit reports, and follow-up issues raised by regulators with respect to the department, health plan, or region. Ensures recommended changes are implemented.
- Oversees process for market area expansion for commercial, Medicare and/or Medicaid products.
- All of the above duties will be undertaken in close coordination with Coventry counsel and corporate governmental affairs personnel.
- May be responsible for special account contractual compliance/reporting.
- May develop and deliver compliance training to local compliance staff.
- Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including employment, termination, performance reviews, salary reviews, and disciplinary actions.
- Performs other duties as required.

Qualifications:

JOB SPECIFICATIONS

- Bachelor's degree or equivalent experience. Master's degree preferred.
- Minimum of 7-10 years of insurance and HMO laws and rules compliance experience.
- Experience with Medicaid/Medicare regulations required.
- Prior QI experience a plus.
- Management experience required.
- Excellent organizational, managerial and analytical skills required.
- Excellent communication skills.
- Proficient with PC applications.
- Demonstrated leadership and team building skills.
 

Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.

Job: Executive/Senior Level Officials and Managers
Primary Location: Harrisburg, PA, US
Organization: 23000 - HealthAmerica Pennsylvania Inc
Schedule: Full-time
Job Posting: 2013-01-22 00:00:00.0
Job ID: 1310256