Health Alliance Plan (HAP) is a regional health plan headquartered in Detroit. Our mission: “to
enhance the health and well-being of the lives we touch.” HAP excels in delivering award-winning disease management, wellness and community outreach programs, and highly personalized customer service.
Under the leadership of the Chief Executive Officer, HAP and the Vice President of Business Integrity Services for HFHS the Chief Compliance Officer (CCO), directs and coordinates all Compliance activities including, those related to Medicare, Medicaid, the State of Michigan and Qualified Health Plan requirements for Health Alliance Plan and its subsidiaries, including Alliance Health and Life Insurance Company; HAP Preferred, Inc.; Administration Systems Research Corporation; and Midwest Health Plan (jointly referred to as HAP).
The CCO has direct access to the HAP Board of Directors for the purpose of advising and making recommendations to the Board about regulatory compliance issues. The scope of responsibilities includes coordinating privacy and security matters with the Information Privacy and Security Office as well as coordinating compliance activities with HAP operational areas.
Principal Duties and Responsibilities:
Nurture and promote a culture of excellence, ownership and compliance throughout HAP in partnership with Governance, Executive Leadership and all members of the workforce.
Implement, document, and maintain a coordinated regulatory compliance program that meets regulatory expectations.
Develop and/or implement compliance educational programs for all key stakeholders.
Identify and assess areas of compliance risks.
Ensure that operations develops and maintains key metrics monitoring compliance with any area considered to be of high risk.
Ensure that policies, procedures and practices are designed to promote compliance with the requirements set forth by regulators, including oversight of all FDR’s, and screening of all required stakeholders against appropriate regulatory data bases. Serve as subject matter expert on compliance matters for HAP staff.
Organize and support the compliance committee structure, including governance (Audit and Compliance Committee of the Board of Directors), the Executive Leadership Team and Corporate Compliance Committee. This includes developing appropriate agendas, reports and information as requested by the committee, CEO, and/or Board.
Develop and communicate annual compliance risk assessments, compliance and audit work plans and effectiveness assessments and make periodic reports of progress toward plans.
Coordinate and oversee regulatory relationships, submissions and reporting activities.
Coordinate external regulatory audits (including those by CMS and Medicaid) as well as any required remediation and/or corrective action plans.
Collaborate in the development of the annual work plan for the Audit and Compliance Committee of the Board of Directors, and ensure that adequate information if provided to the Committee to complete the work plan.
Develop and present reports to the CEO and/or Governance as required.
Oversee and follow up and as applicable implement corrective actions to investigations and other issues generated by the compliance program.
Coordinate or oversee compliance activities with other departments and sources as necessary
Bachelor's degree in health care administration, public health or business.
Seven plus (7+) years of related experience and/or training.
Previous Medicare, Medicaid, FEHB, HIPAA and federal health reform regulatory experience in a managed care entity. Successful development and implementation of government programs compliance plan.
Compliance experience related to oversight of governmental sponsored insurance products (CMS, Medicaid, etc.) preferred. Excellent verbal, written, listening and interpersonal communication skills.
Knowledge of managed care external accreditation requirements, such as National Committee on Quality Assurance.
Flexibility, adaptability to changing business and personal needs. Leadership skills, ability to coach and mentor.
Knowledge of Medicare and Medicaid managed care//insurance regulations and environment.
Acquire knowledge of compliance trends by attending educational meetings on compliance and reporting back learned information.
Ability to foster a cohesive and supportive team environment.
CERTIFICATIONS/LICENSURES REQUIRED: Certification in compliance field by organizations such as the Health Care Compliance Association (HCCA) or National Health Care Anti-fraud Association (NHCAA) preferred.
Internal Number: 184512
About Health Alliance Plan (HAP)
Health Alliance Plan (HAP) is a nonprofit, regional health plan headquartered in Detroit.
Our mission: “to enhance the health and well-being of the lives we touch.”
HAP excels in delivering award-winning disease management, wellness and community outreach programs, and highly personalized customer service.
Henry Ford Health System Alignment:
• HAP is a subsidiary of Henry Ford Health System, one of the national’s leading health care systems and a proud recipient of the 2011 Malcolm Baldrige National Quality Award for performance excellence and innovation.
• HAP serves an important role in promoting system integration and care coordination and acts as a catalyst in forming innovative patient care, community, business and economic partnerships. As the voice of the customer, HAP partners with HFHS to improve quality while maintaining a focus on value, affordability and accessibility.
• HAP has more than 1,300 employees in Detroit, Southfield, Flint and Grand Rapids.
• We serve more than 650,000 members through six product lines:
o Group Insured Commercial: PPO, EPO and HMO; Health Engagement programs offer employees incentives to adopt a healthier lifestyle.
o Indi...vidual: HAP Personal Alliance PPO, HSA and Short-Term health plans are for individuals and families not covered through employer health insurance.
o Medicare Solutions: HAP Medicare Solutions offer PPO and HMO plans, prescription drug plans, and Medicare Supplement plans for individuals and employer-sponsored retirees.
o Medicaid: HAP Midwest Health Plan has about 10,000 Medicare and Medicaid enrollees.
o Self-Funded: HAP and ASR Health Benefits offer competitive options for Michigan companies and health and welfare funds seeking to self-fund their health benefit costs.
o Network Leasing: Statewide PPO network that can be administered by Third Party Administrators and Welfare Funds