Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.
What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.
If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.
The Vice President, Chief Compliance Officer will oversee and administer all day-to-day compliance program activities for Bright HealthCare, which is Bright Health Group’s health plan business unit, including individual commercial market, Medicare, and Employer coverage lines of business.
The Vice President, Chief Compliance Officer job description is intended to point out major responsibilities within the role, but it is not limited to these items.
1. Oversee, administer, and implement the Bright HealthCare’s core day-to-day compliance program, including the following:
a. Bright HealthCare’s Executive Compliance Committee
b. Enterprise-wide Policy and Procedure management.
c. Compliance training and education programs.
d. Fraud, waste and abuse plan development and administration.
e. Internal annual audit plan development and administration.
f. External regulatory audit management.
g. Annual compliance risk assessment administration.
h. Annual compliance program work plan development and execution.
i. Delegation oversight administration, including vendor and first-tier, downstream, and related entity delegation oversight and monitoring.
Manage compliance program hotline and oversee all hotline inquiry response activities
2. Draft and present periodic compliance reports and annual compliance program evaluations to the executive compliance committee, senior leadership and company board of directors.
3. Facilitate the executive compliance committee, including developing agendas, reports, and information as requested by the committee, senior management, and/or the board of directors.
4. Lead and manage compliance program team members, including direct reports representing all key areas of the compliance program.
5. Monitor the performance of the company’s compliance program, day-to-day compliance issues and risks, and activities to close identified gaps.
6. Oversee a system for tracking identified compliance issues and risks across the entire Bright HealthCare business unit.
7. Oversee, follow-up, and, as applicable, implement corrective actions to investigations and other issues generated by the compliance program.
8. Coordinate or oversee regulatory submissions and reporting activities. This includes collaborating with other departments to ensure regulatory reporting timelines, project plans, and responses to regulatory inquiries are timely and correctly answered.
9. Act as a cultural ambassador to maintain a strong corporate culture of compliance.
10. Other duties and responsibilities as assigned.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
• Bachelor’s degree required; Master’s, Juris Doctor, or equivalent graduate degree preferred.
• 8+ years’ experience in health care regulatory compliance and compliance leadership.
• Health plan compliance leadership experience.
• Extensive knowledge of industry standard health plan compliance practices, CMS Medicare Advantage requirements, individual Affordable Care Act requirements, small/large group requirements, and applicable state insurance laws.
• Successful team management and leadership experience.
• Experience managing relationships with state and federal government agencies.
• Exceptional written and oral communication skills.
• Experience organizing and managing large volumes of information and data in effective and efficient systems.
• Strong experience and comfort with performance management and collaboration.
The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Travel may be required.
We’re Making Healthcare Right. Together.
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.