Promotes and maintains a culture of compliance through researching and providing guidance to business areas on a variety of regulations and standards. Monitors changes and trends in federal/state healthcare laws, regulations and programs impacting the organization. Serves as a liaison to the business areas to assess potential regulatory impact on operations, recommends appropriate actions, and confirms regulations are implemented. Supports MVP’s compliance network through collaboration with designated point persons throughout MVP to further develop MVP’s Compliance Program.
Interacts frequently with the Corporate Compliance Officer. Also interacts frequently with the Operational Compliance Leaders and the members of MVP’s compliance network. Interacts with members of management as needed to implement regulatory requirements. External contacts include regulatory agencies and representatives such as the DFS, the New York State Department of Health and other regulatory agencies.
ESSENTIAL JOB FUNCTIONS:
Monitors changes and trends in federal/state healthcare laws, regulations and programs and industry standards impacting the organization;
Assesses potential impact of regulatory and industry changes on operations and recommends appropriate actions to achieve compliance;
Facilitates compliance with regulatory and industry changes by working collaboratively with the affected business areas to develop impactful and compliant solutions;
Develops a communications plan when appropriate to ensure new requirements are appropriately communicated to the impacted business areas;
Advises and educates the business areas about compliance matters and the impact of recent regulatory and legislative changes and guidance;
Serves as a resource to employees for compliance-related regulatory questions;
Collaborates with the Operational Compliance Leaders to ensure consistency across MVP;
Enhances MVP’s compliance network through collaboration with all of MVP’s assurance functions to further develop MVP’s Compliance Program;
Oversees the Compliance Network (and any subgroups), including developing agendas, leading meetings, addressing issues, and following up as necessary;
Utilizes the integrated risk management system to track, report, analyze and trend compliance-related data;
Communicates compliance risks from the integrated risk management system to the Corporate Compliance Officer;
Works with the Corporate Compliance Officer, Operational Compliance Leaders, the Compliance Network, and management to address potential and/or actual compliance issues;
Maintains and updates policies, procedures and standards of conduct related to compliance as required;
Participates in committees and provides verbal and written status updates on the impact and implementation of new and revised regulatory requirements as requested by the Corporate Compliance Officer;
Completes special projects and other duties as assigned.
OTHER DUTIES & RESPONSIBILITIES:
Ability to maintain confidentiality and adhere to regulatory compliance issues as they exist and change from time to time; Performs other related duties as assigned.
Bachelor’s Degree in law, business, or related field required; and Juris Doctor (JD)
MINIMUM YEARS’ EXPERIENCE:
3-6 years of experience in a health insurance environment or in a compliance program in health insurance required.
Experience in researching, analyzing and interpreting regulatory requirements in a clear and concise manner required
Experience working with regulatory agencies required
Project management experience required
Strong technical ability with fluency in Microsoft Office Suite products (Outlook, Word, Excel, PowerPoint, Teams, etc.)
Demonstrated skills in researching and interpreting state and federal regulations; experience with the New York State Department of Financial Services rules and regulations (or other state equivalent)
Experience working with an integrated risk management system preferred
Excellent written and oral communication skills; ability to communicate across a variety of audiences
Certification in healthcare compliance or related area through organizations.
Ability to exercise sound judgement on issues that are material to the organization’s performance
Must be able to forge strong relationships with personnel in different disciplines and at all levels of the organization
Able to influence key stakeholders throughout company for effective execution
Open minded and embraces ideas of others; self-motivated, organized problem solver
Experience working both independently and in a team-oriented, collaborative environment
Normal office working environment
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Internal Number: 600
About MVP Health Care
Be a part of the transformation at MVP Health Care®. MVP Health Care is a nationally-recognized, regional not-for-profit health insurer. We care for more than 700,000 members across New York and Vermont and are powered by the ideas and energy of more than 1,700 employees. We employ talented people with diverse backgrounds and experience—tech people, numbers people, even people people—to make health insurance more convenient, more supportive, and more personal. If you’re ready to join a thriving, mission-driven company where you can create your own opportunities—it’s time to make a healthy career move to MVP.