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PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.
Position Overview: Responsible for administering and managing the enterprise's Compliance Program. This leadership position is responsible for monitoring and reporting the status of compliance program effectiveness to the CEO, Executive Management Groups and the Audit and Compliance Committee of the PacificSource Boards of Directors. Continually evaluate and update the Compliance Program via development and execution of the annual Compliance Work Plan, and by influencing the appropriate elements within the company's Strategic Work Plan and performance dashboard. Ensure PacificSource maintains full compliance with all governmental agencies, including all Federal and State regulatory agencies. This position also services as the company's Privacy Officer.
- Oversee and directly manage the enterprise's Compliance Program for all lines of business. Develop, maintain and update policies and procedures for the general operation of the Compliance Program throughout the organization. Manage day-to-day operation of the Program, and develop performance metrics and routine monitoring mechanisms to evaluate its ongoing effectiveness.
- Chair the corporate Compliance Committee, and utilize this multi-stakeholder leadership group to enable consistently strong compliance performance, and to maintain a culture of Compliance within the organization.
- Serve as the organization's Privacy Officer performing various functions including without limitation performing risk assessments, updating policies and procedures to comply with State and Federal privacy regulations, maintaining the required disclosure information and fulfilling the organizations' obligations under state and federal privacy regulations.
- Lead investigation and assessment of all HIPAA breaches.
- Maintain expert knowledge of health insurance industry rules and regulations, track all regulatory changes, and develop effective mechanisms to ensure the company responds appropriately to all regulatory changes.
- Develop effective lines of communication with all internal departments to ensure regulatory changes are adopted and monitored consistently and appropriately. Ensure escalation protocols are in place to address areas of underperformance with senior leadership.
- Maintain productive relationships with key regulatory agencies and leaders, at the State and Federal level.
- Identify potential areas of compliance risk and vulnerability throughout the organization, and within all lines of business. Through the annual Compliance work plan, develop and oversee audit and monitoring protocols that evaluate the company's performance in known high risk areas. Work with functional and departmental leaders to develop improvement and corrective action plans for identified risk areas.
- Work closely with the Internal Audit department to ensure synergy between Compliance and Audit work plans, and to ensure effective audit and monitoring as it relates to the Compliance Program.
- Develop and implement an effective compliance training program, including appropriate introductory training for new employees and ongoing training for all employees and managers and the Board of Directors.
- Provide reports on a regular basis, and as directed or requested, to executive leadership and the Audit and Compliance Committee of the Board, and keep them informed of the operation and progress of compliance efforts.
- Oversee regulatory oversight activities related to all of the organization's lines of business with external auditors. Develop monthly, quarterly and annual reports related to all of the organization's lines of business to regulatory agencies, as required.
- Consult with General Counsel as needed to resolve difficult legal compliance issues.
- Respond to alleged violations of rules, regulations, policies, procedures and Code of Conduct and Ethical Standards by evaluation or recommending the initiation of investigative procedures.
- Act as an independent review and evaluation body to ensure that compliance issues and concerns related to all of the organization's lines of business are being appropriately evaluated, investigated, and resolved. Work directly with regulatory agencies as appropriate. Ensure proper reporting of violations or potential violations to duly authorized enforcement agencies as appropriate or required.
- Provide direction for the company's Fraud, Waste and Abuse program. Oversee management of the fraud and abuse hotline for all of the lines of business, including conducting preliminary investigations of reports made.
- Institute and maintain an effective compliance communication program relating to all of the organization's lines of business, including promoting:
- Use of the fraud and abuse hotline;
- Heightened awareness of Code of Conduct and Ethical Standards;
- Understanding of new and existing compliance issues and related policies and procedures.
- Responsible for oversight, management, development, implementation and communication of department programs.
- Responsible for hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-ones and performance evaluations, for direct reports.
- Develop annual department budgets. Monitor spending versus the planned budgeted throughout the year and take corrective action where needed.
- Coordinate business activities by maintaining collaborative partnerships with key departments. Responsible for process improvement and working with other departments to improve interdepartmental processes. Utilize lean methodologies for continuous improvement. Utilize visual boards and daily huddles to monitor key performance indicators and identify improvement opportunities.
- Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy.
- Meet department and company performance and attendance expectations.
- Perform other duties as assigned.
Minimum 8 years' experience in the healthcare or health insurance industry with specific Compliance experience within both Government and Commercial lines of business compliance. Preferred 3-5 years' experience at a Compliance leadership level.Education, Certificates, Licenses:
Bachelor's degree in Business, Health Care Administration, Finance, Accounting or a related field. Master's Degree preferred.Knowledge:
Ability to gain a thorough understanding of, and contribute to, PacificSource strategic plan and annual work plans. Experience interfacing with Boards of Directors, and Board Committees. Extensive knowledge of Medicare, Medicaid, and Commercial laws and regulations affecting the industry. Respond timely to regulatory inquiries. Maintain effective relationships with regulatory agencies. Keeps the enterprise informed of new regulatory developments. Maintain sufficient reference materials to adequately research legal issues. Working knowledge of medical terminology. Ability to read and understand health contract and benefits language. Ability to work under time pressures, and to deal with emotional situations. Ability to work effectively with internal departments and staff, at all levels, to facilitate excellent services for PacificSource customers. Requires ability to define and prioritize problems and manage workload without direct supervision. Ability to type using a standard keyboard, operate a 10-key pad accurately, and use a PC.Competencies
- Building Organizational Talent
- Coaching and Developing Others
- Compelling Communication
- Customer Focus
- Emotional Intelligence
- Leading Change
- Managing Conflict
- Operational Decision Making
- Passion for Results
Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 20% of the time.Our Values
We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
- We are committed to doing the right thing.
- We are one team working toward a common goal.
- We are each responsible for customer service.
- We practice open communication at all levels of the company to foster individual, team and company growth.
- We actively participate in efforts to improve our many communities-internally and externally.
- We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
- We encourage creativity, innovation, and the pursuit of excellence.
Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.Disclaimer:
This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
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