Job Information
Elevance Health Kansas Medicaid Plan Compliance Director in TOPEKA, Kansas
Compliance Officer/Director
Location: Topeka Kansas
This position will take part in Elevance Health's hybrid workforce strategy which includes virtual work and 2-3 days in office per week.
The Plan Compliance Officer/Director owns oversight to ensure monitoring is performed in compliance with the Kansas state contract requirements and connects with state plan leaders and centralized government business process leaders to understand business level monitoring of compliance with state requirements.
How You Will Make an Impact
Primary duties with expert skill level and tasks with the most advanced complexity and broad/enterprise scale may include, but are not limited to:
Reviewing state defined quality metrics performance, vendor and affiliate monitoring and audit performance.
Regulatory monitoring and research, overseeing regulatory audits or exams, regulatory filings, executive-sponsored initiatives, risk assessments, conducting mock audits, conducting audit training, assessing audit preparedness.
The central driver of issue remediation, confirming our business partners understand and address the root cause and control breakdowns that lead to member, provider, and state complaints/issues.
Researches and responds to questions about requirements in the contract, and state-based interpretation and enforcement of those requirements and owns the Kansas Medicaid Compliance Committee.
Supports business development and maintenance of the contract through request for proposal support.
Supports health plan leaders with business operational reviews with senior Medicaid leadership.
Meets with the key regulatory contacts biweekly or more often as needed, ensuring the health plan is meeting regulatory expectations.
Supports Elevance’s Audit COE in understanding the state requirements that are being audited against, and the key state health plan leaders (local and centralized) responsible for each area of the audit.
Review collateral and member messaging developed that would be distributed to members for the state (local, compliance related, and centralized).
Performs reviews of policies and procedures developed locally, and for centralized support to ensure compliance with state contracts.
Leads compliance monitoring to identify and address compliance risks and manage action plans designed to fully mitigate risk(s).
Develop strong relationships with key leaders to ensure company and subsidiaries have thorough, accurate regulatory information on which to base business decisions.
Minimum Requirements:
- Requires a BA/BS and minimum of 8 years health care, regulatory compliance or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities, and Experiences:
Kansas compliance knowledge highly preferred.
Strong leadership/managerial skills and ability to motivate/coach other staff strongly preferred.
MS/MBA/JD or professional designation preferred.