Working in concert with other Functional Heads, and in support of the priorities and policies of the OHP Board of Directors, this job is responsible for Medicare compliance oversight and is accountable for a broad range of critical Medicare compliance activities, including the OHP privacy program. Accountable activities include ongoing program management, improvement, investigations, policy development, creation of reports and presentations for the Compliance Committee, and collaboration with internal business partners and external individuals, including delegated entities, CMS Account Manager, and other CMS regulators.
Serves as a subject matter expert on Medicare compliance and privacy matters including answering interdepartmental questions concerning various Medicare topics while partnering with other business areas to integrate and deliver on Medicare compliance requirements, develops and conducts annual risk assessments and audit work plans for the Medicare line of business, and continually monitors and improves internal and external audit and monitoring processes to ensure that the organization, as well as vendors, are compliant with applicable laws.
Plans overall OHP compliance and privacy strategy (in concert with strategic initiatives of the Board of Directors, strategic plan and operational plan)
Manages recruitment and develop of team including succession planning, training and development, recruitment, etc.
Manages operational controls including monthly reports, quarterly reviews and supplemental action programs.
Oversees product development including overall strategy, quarterly priority meetings, status reports, new products and development expense.
Oversees daily compliance of all OHP operations, manage relationships and provide oversight for all partners and vendors.
Oversees daily privacy compliance to keep member information safe and programs compliant with regulatory standards.
Performs other related duties as assigned.
Required – Bachelor's degree in political science, law, health administration or related field
Preferred – Master’s degree
Required – 10 years of compliance, audit, and government affairs experience or Master’s degree
5 years’ experience working within a health plan (Commercial and/or Government) or working in concert with health plans
Internal Number: REQ_00088904
About Ochsner Health
Ochsner Health is a system that delivers health to the people of Louisiana, Mississippi and the Gulf South with a mission to Serve, Heal, Lead, Educate and Innovate. Ochsner Health is a not-for-profit committed to giving back to the communities it serves through preventative screenings, health and wellness resources and partnerships with innovative organizations that share our vision. Ochsner Health healed more than 876,000 people from across the globe in 2019, providing the latest medical breakthroughs and therapies, including digital medicine for chronic conditions and telehealth specialty services. Ochsner Health is a national leader, named the top hospital in Louisiana and a top children’s hospital by U.S. News & World Report. As Louisiana’s leading healthcare educator, Ochsner Health and its partners educate thousands of healthcare professionals annually. Ochsner Health is innovating healthcare by investing in new technologies and research to make world-class care more accessible, affordable, convenient and effective. Ochsner's team of more than 26,000 employees and 4,500 providers are working to reinvent the future of health and wellness in the region. To learn more about Och...sner Health, please visit www.ochsner.org. To transform your health, please visit www.ochsner.org/healthyyou.