Compliance Program Manager Rockville MD Rockville, MD
The purpose of this role is to manage, provide guidance to, and monitor the processes necessary to ensure regulatory compliance of administrative departments as relates to federal/local insurance regulatory requirements, including those required under the Patient Protection and Affordable Care Act (Health Care Reform). The candidate filling this position shall participate in cross-functional teams responsible for the development and deployment of new/revised products and benefits in the region, and shall act as a resource to the MSBD and HPSA operational areas to address compliance or regulatory concerns. The role will also include conducting or participating in assessments of administrative business practices, as well as review of marketing and member communications for compliance with both federal and regional insurance regulations.
- Act as an expert for regional compliance with state/local insurance regulatory requirements that relate to EOCs and other member materials, working closely with PO Legal.
- Review for approval or revision proposed commercial, marketing and other Member, Employer, and Broker materials, such as collateral materials, EOCs, plan documents provider directories. Also review proposed local legislation addressing insurance products.
- Participate in the regional implementation efforts of the ACA, including representing the region on national and regional committees.
- Create compliance tools, such as checklists and other documents, to assist administrative departments incorporate compliance requirements into their processes.
- Maintain a detailed and ongoing knowledge of local jurisdictional insurer/payor regulatory laws and regulations, as well as applicable federal laws to which the Region is subject. Examples include PPACA (Health Care Reform), COBRA, HIPAA Portability, and ERISA.
- Perform periodic probe audits and assessments of selected functions performed by business units to assess status of compliance with regulatory requirements.
- Train or assist with the training of new or existing staff on various aspects of regulatory compliance which relate to the various KP products.
- Chair ad hoc committees as necessary.
- Work with business units to review policies and procedures to document internal processes which support compliance with internal and regulatory requirements.
- Establish and/or maintain positive working relationships with the insurance regulators of Maryland, Virginia and the District of Columbia.
- Other duties as assigned.
- Minimum five (5) years of experience in a commercial health insurance product and/or health insurance product regulatory setting required, with a strong preference for such experience related to VA, MD and DC health care regulation (insurance experience related to life/casualty/property insurance, or IT/HIPAA/Security/financial compliance does not meet this threshold).
- Bachelor's degree required.
License, Certification, Registration
- Ability to successfully engage peers in self-managed teams to meet deadlines and to communicate successfully with senior leaders required.
- Ability to negotiate complex issues, and engage in conflict resolution as needed, with internal clients and with external groups is required.
- Excellent interpersonal skills and demonstrated oral and written communication skills are required.
- Minimum three (3) years of project management experience preferred.
- Insurance or regulatory experience with PPACA is strongly preferred.
- Experience with auditing is preferred.
- Certified In Health Care Compliance (CHC) Certification preferred.
- Master's degree or JD preferred.
Primary Location: Maryland,Rockville,Rockville Regional Offices 2101 E. Jefferson St.
Scheduled Hours (1-40): 40
Working Days: Mon - Fri
Job Type: Standard
Employee Status: Regular
Employee Group: Salaried, Non-Union, Exempt
Job Level: Manager with Direct Reports
Job: Legal / Government Relations
Public Department Name: Regional Compliance
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
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