Director - Policy & Compliance

It's a great time to put the strength of Coventry Health Care behind your career!
We are currently seeking a Director of Policy and Compliance for our Government Programs department at our Bethesda, MD corporate office.

This position is responsibile for the overall direction of multiple business operational areas within the Policy & Compliance division to meet or exceed business objectives.

ESSENTIAL RESPONSIBILITIES: Develops programs and processes in support of corporate objectives in the areas of regulatory/legislative compliance. May directly manage/coordinate such projects after implementation or may delegate that responsibility to other persons as appropriate. Performs data analysis and develops summaries and/or recommendations on programs and projects for corporate officers. Analyzes all state and federal legislation that will impact service operations, coverage, or require product modifications; lead cross-disciplinary work groups to ensure cost effective compliance. Ensures that processes are in place to respond to customer complaints, grievances and appeals and expressions of dissatisfaction directed to the President and other officers, as well as attorney correspondence. Responsible for the development of policies and procedures to ensure compliance with the statutes, regulations, and guidelines of standards of accrediting and/or oversight agencies, such as NCQA, URAC, CMS, OIG, and OCR. Prepares reports required for regulatory compliance. Coordinates programs for detection and prevention of fraudulent claims submissions. Oversees coordination of all recovery efforts related to incorrect claim payments and quality/defect program development. Builds and maintains collaborative relationships and alliances with internal customers corporate-wide including, but not limited to, service center management, Plan leadership, provider relations, medical management, marketing, and finance to achieve business goals. Develops strategic, operational and tactical business plans to achieve desired business goals for responsible operational areas. Coordinates resources (financial, capital, human, etc.) to ensure that programs and projects have sufficient means to meet/exceed expectations. Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including employment, termination, performance reviews, salary reviews, and disciplinary actions. Develops an administrative budget and works with service operations managers to manage the budget and control expenses. Rewards employees based on the development and utilization of required skills and competencies that contribute to the achievement of business objectives. Maintains a positive work environment and structure that supports self-directed teams and optimizes the experience, skill, knowledge and capability of the team. Performs other duties as required.
REQUIREMENTS
The successful candidate will have:
Bachelor’s degree or equivalent experience. Significant experience in health care (usually 10 years) with management responsibility for legislative and regulatory affairs, insurance industry organizations, national accrediting agencies and risk management. Knowledge of state and federal laws and regulations affecting insurance operations. Demonstrated leadership and motivation skills. Ability to initiate and drive change; demonstrated results-driven approach. Demonstrated process and project management ability. Ability to develop and implement service strategies for internal and external customers.

To apply for this position, please visit our Career Center at http://careers.cvty.com, referencing job code #18400.