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We are searching for a Director of Regulatory Compliance -- someone who works well in a fast-paced setting. In this position, you will develop, lead, and ensure the integrity and the ongoing effectiveness of the compliance program for the Texas Children's Health Plan (TCHP). To develop and execute the work plan as approved by the appropriate governing bodies and/or executives. This position and leader oversee the Fraud & Abuse Program at TCHP and the ongoing activities which support TCHP's regulatory monitoring and auditing activities. This leader also works across the organization as an advocate and change leader to promote compliance with applicable State and Federal rules.
Skills & Requirements
· Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children’s unless approved for a medical or religious exemption.
· Required Bachelor's Degree. With a preferred Master's Degree in Business, healthcare or legal field and Juris Doctor Degree (JD) Business, healthcare, or legal field
· Licenses/Certifications: CHC - Certified in Healthcare Compliance, CCEP - Cert Compliance & Ethics Prof, CHPC - Cert Healthcare Privacy Compliance
· 8 years of regulatory, compliance, and/or medical billing experience, including at least one (1) year of formal leadership experience
· A JD or Master's Degree will substitute for two (2) years of compliance experience.
Job Duties & Responsibilities
· Organizes, coordinates, and oversees the work of departmental personnel to ensure that the Compliance Work Plan (and/or SIU/Fraud Waste & Abuse Work Plan) is completed with leading and high-quality reporting and recommendations. Successfully leads and completes Fraud, Waste, and Abuse activities, Special Investigative Unit, Internal, and External Audits, and works very effectively in an integrated and coordinated fashion and approach with all applicable departments. Maintains ongoing reviews and analyses related to budget performance and department resourcing.
· Responsible for the management of personnel’s time and department resources. Monitors progress for completion of projects within established timelines through direct supervision of staff. Conducts annual assessments of personnel training needs and uses internal and external sources, within budget, to ensure staff has the skills and knowledge to perform work plans. Performs and documents thoughtful and timely performance evaluations (including Annual Performance evaluation).
· Leads the monitoring and reviews of the design and execution of CAPs (internal and regulatory corrective action items/plans). Performs regulatory-required vendor oversight monitoring activities and works closely to evaluate and make recommendations for decentralized vendor or contract review procedures and controls.
· Chairs and prepares to lead Compliance and Subcommittee meetings, presentations, and training. Continuously identifies and designs and leads trainings across TCHP, and as applicable training coordination with the System.
· Maintains and monitors regulatory and contractual reporting requirements, is a leading influencer regarding ensuring that regulatory deliverables are adequately monitored and evaluated for accuracy and completeness.
· Identifies, evaluates, recommends, and escalates heightened awareness regarding regulatory compliance risks, gaps, and/or areas of non-compliance.
· Recommends and assists in the development of policies and procedures with respect to regulatory compliance. Identifies opportunities for integrating compliance activities within existing process flows.
· Develops and implements annual compliance communication plan for TCHP. Coordinates communication efforts with TCH Compliance to ensure effective and timely communications
· Oversees annual compliance training completion for TCHP staff. Develops and executes job specific regulatory compliance training and education to comply with regulatory requirements.
· Coordinates regulatory change management efforts with relevant TCHP departments and integrates regulatory compliance updates as appropriate
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