Anthem Regulatory Compliance Director(Program Integrity) -128674 in Louisville, Kentucky

/ Your Talent. Our Vision. / At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care .

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.


Preferred Location: May work from any Anthem location or telecommute. *

The Regulatory Compliance Director is responsible for planning and directing policies, programs and initiatives related to regulatory compliance for Program Integrity. They will serves as a department Lead and champion of Program Integrity’s regulatory and compliance team. This position has the opportunity to build our compliance program operating model. They will serve as the main point of contact/subject matter expert on all matters Program Integrity to include: Regulatory Requests, Audits, RFP’s, RFI’s, Contract Changes, Meetings. This position would demonstrate extensive knowledge of regulatory and contract requirements/CMS regulations, and internal data gathering process. Team is responsible for reviewing all LOB contracts for Program Integrity deliverables. Maintain oversight and ownership of all data gathering related to Health Plan regulatory reports. Each functional area, including SIU, would compile required information and supply to the this position for final submission. Works with health plan leaders, oversees the monitoring and enforcement of the fraud, waste, and abuse compliance program to prevent and detect potential fraud, waste, and abuse activities pursuant to state and federal rules and regulations. Primary duties may include, but are not limited to: - Has detailed technical knowledge of Program Integrity and participates on cross functional teams focused on problem remediation and long term resolution. - Anticipates the effect of changes in the business environment. - Evaluates regulatory compliance changes to determine potential impact. - Evaluates provider activities to assist in the detection of fraud, waste and abuse activities. - Monitors provisions of the compliance plan, including fraud, waste, and abuse policies and procedures, investigates unusual incidents and implements corrective action plans. - Develops and analyzes monthly reports. - Develops project plans and oversees project execution, issue management and progress reporting. - Develops processes to support early detection of systemic issues causing operational inefficiencies. - Designs and implements programs, policies and practices to ensure compliance - Maintains compliance with federal, state and local regulatory requirements. - In conjunction with management, formulates and establishes company policies, operating procedures, and goals. - Monitors compliance standards and coordinates all aspects of implementation including privacy, security and training. - Evaluates existing policies and procedures to coordinate internal practices and to ensure compliance with regulations.

Requires:

  • BA/BS; 8 years of healthcare compliance related experience; or any combination of education and experience, which would provide an equivalent background.
  • Experience with Program Integrity is preferred.

  • Extensive experience in a regulatory and compliance role highly desired. // /Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at// antheminc.com/careers //. EOE. M/F/Disability/Veteran./

    /*

// /*

Job Fraud

Title: Regulatory Compliance Director(Program Integrity) -128674

Location: KY-Louisville

Requisition ID: 128674