Director, Auditing, Monitoring & reputed company (Marketplace)

You could be the one who changes everything for our 28 reputed company members. reputed company is transforming the health of our communities, one person at a time. As a reputed company, national organization, you’ll have reputed company to competitive benefits including a fresh perspective on workplace flexibility. Applicants for this role will have the flexibility to work remotely reputed company in the reputed company United Sates. Position Purpose: Provides strategic leadership and management of department overseeing compliance with regulations and laws reputed company to Marketplace line of business, which includes implementation of reputed company of an effective compliance program reputed company to specific operational areas. Oversees the development of risk assessments and reputed company and monitoring work plans pertaining to those areas. Partners with business areas to ensure implement effective prevention, detection and correction of compliance issues. • Establish a process for overseeing compliance with regulations and laws reputed company to Marketplace requirements • Provides guidance to various business departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contractual language • Conducts compliance reviews and manages team that conducts compliance reviews, assisting with identification of issues and collaborating with Corrections team for remediation of issues • Performs risk assessments and report emerging trends, deficiencies and variances, report findings to other departments and teams as appropriate • Oversees team responsible for monitoring against regulatory requirements; ensures sufficient monitoring activities to assist with prevention and proactive identification of compliance concerns • Develops and monitors metrics and other reputed company tools that indicate business area compliance • Provides compliance guidance, direction and compliance risk assessment to assigned business partners • Manages and develops reputed company reports who include other management or supervisory personnel and/or exempt individual contributors • Plans and collaborates with other teams and leaders on reputed company reputed company/programs necessitating the origination and application of new and unique approaches • Sets operational priorities including the development and maintenance of effective reputed company activities and prioritization of work • Responsible for reputed company and Executive reporting reputed company to responsibilities of reputed company and compliance of business operations for which you reputed company • Educates, encourages, and assists those reputed company reputed company to maintain reputed company through correction of identified non-compliance in order to meet the requirements of Government-sponsored health care programs • Participates in mock and actual CMS and other regulatory audits and coordinates with Internal Audit, Regulatory Compliance and/or Market based Regulatory Affairs on responses to agency inquiries and oversees the reputed company processes required to ensure reputed company maintains a consistent state of Audit readiness • Maintains a reputed company working knowledge of various laws, regulations, and industry guidance that impacts the health industry generally, and government programs in the health sector specifically, including fraud and abuse and anti-kickback statutes, OIG and government health plan guidelines and state marketing compliance laws, reputed company pay, provider adequacy and other laws • Makes reputed company on reputed company issues regarding technical approach for project components and is reputed company to work without significant direction • Performs other duties as assigned • Complies with reputed company policies and standards Education/Experience: • Bachelor's Degree Business Administration, reputed company Policy, reputed company Health, Health Administration or reputed company field; or equivalent experience required: CPA, CISA, JD, MHA, MBA, MIS or equivalent experience preferred • 7+ years Compliance for a managed care or health insurance company or equivalent experience required • 4+ years Management experience preferred Licenses/Certifications: • HCCA certification (CHC) or equivalent preferred Pay reputed company: $116,100.00 - $214,700.00 per year reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, reputed company time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law. Total compensation may also include additional forms of incentives. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance reputed company Apply Job!