Regulatory Compliance (40%)
- Manage compliance policies; ensure policies are up to date through periodic review by subject matter experts; communicate policy changes as needed.
- Stay current with CMS regulatory guidance and other relevant federal and state compliance laws and regulations and modify the compliance program accordingly to remain compliant, as well as consistent with industry best practices.
- Advise on and negotiate CMS and other regulatory provisions in customer, vendor, and partner contracts
Corporate Compliance (30%)
- Oversee all aspects of internal training for Wellframe, including, for example, new employee orientation, annual online training and department-specific training.
- Manage enablement materials for cross-functional stakeholders on current and emerging compliance issues to influence how Wellframe thinks about relevant laws.
- Document and review potential conflicts of interest.
- Assist with maintenance of Wellframe’s Code of Conduct and Business Ethics and Employee Handbook.
- Maintain records and documentation necessary to demonstrate compliance with applicable laws and regulations.
- Assist with assessments assigned by customers and prospects.
- Evaluate new products and programs for potential compliance issues, and oversee remediation when issues arise; translate legal requirements into actionable advice for product and engineering teams.
- Answer questions from internal departments about various topics and participate on teams that need to integrate or deliver compliance requirements.
- Work across all departments to identify compliance risks, trends, vulnerabilities, and research solutions for risk mitigation.
- Update senior management and department directors on changes in compliance requirements, expectations, and regulatory requirements.
Education, Experience, & Skills Required
- Minimum of 7 years work experience in monitoring compliance with Medicare and Medicaid regulations, preferably within the health insurance industry.
- Bachelor’s degree in health information management, business, healthcare, or related field; JD a plus but not required.
- Certification in Healthcare Compliance required.
- Experience with medical device regulation preferred.
- Demonstrated ability to comprehend and interpret regulatory, legislative, and contractual mandates.
- Broad-based in-depth knowledge of the managed care industry, including: strategic compliance planning, regulatory concerns, compliance requirements, and corporate integrity principles.
- Record of collaboration and effective management of a compliance program.
Behaviors & Traits Required:
- Excellent analytic skills and ability to effectively establish and achieve compliance requirements in collaboration with other teams.
- Acts independently; determines methods and procedures on new, special or unique tasks or projects.
- Strong written and verbal communication skills.
- Comfortable with changing requirements and navigating ambiguity.
- Generally adept at picking up new technologies.
- Support Wellframe’s mission by exhibiting Tenacity, Humility, and Collaboration.