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Resp & Qualifications

PURPOSE:

The VP, Ethics & Compliance oversees and manages the Company's Corporate Ethics & Compliance Program, serving as an independent and objective individual that reviews and evaluates compliance issues and concerns within the organization. This position is responsible for planning, directing, implementing and managing the Company's ethics & compliance activities, and the Corporate Policy Management Program. The Vice President, Ethics & Compliance establishes, implements, monitors, and reports on an effective compliance program to prevent and detect illegal, unethical, or improper conduct. The position is responsible for collaborating and coordinating with various divisions within the Company to assist in identifying, assessing and correcting areas of compliance risk for the Company in an effective, ethical and appropriate manner. Reports directly to the Audit and Compliance Committee of the Board of Directors with day to day and administrative reporting to the Chief Risk Officer.

ESSENTIAL FUNCTIONS:

Establishes and maintains an effective compliance program to promote awareness and compliance with CareFirsts mission, values, ethics, applicable laws, policies and standards by, among other things, implementing effective and business-savvy policies, procedures, and trainings; ensuring open and effective lines of communication at all levels of the organization; and driving enterprise-wide compliance and regulatory affairs initiatives.

o Responsible for the development, continual improvement and operation of the Companys E&C Program, including expanding visibility for the Program at all levels throughout the organization and effectively collaborating with key stakeholders to promote compliance.

Oversee Medicare and Medicaid Compliance functions and related staff functions.

o Serves as the primary contact for Centers for Medicare and Medicaid Services (CMS) for Medicare compliance communications.

o Responsible for ensuring overall compliance with all Medicare compliance activities and programs and evaluating and implementing changes to compliance processes due to new or amended regulations.

Acts as independent reviewer and evaluator to ensure that E&C concerns within the organization are appropriately evaluated, investigated and resolved.

o Responsible for approving final resolution of identified Code of Conduct violations.

o Oversee the annual compliance training, corporate communications, and facilitate effective and efficient policy management.

o Monitor the development of and review the annual Compliance Risk Assessment and compliance workplan(s) and provide commentary to determine their effectiveness in reducing the risk of unlawful, unethical, or improper conduct at CareFirst.

Participate in the development of Corrective Action Plans (CAPs) for resolution of problematic issues and provide general guidance on how to avoid or deal with similar situations in the future.

o Oversee the management of CAPs throughout the organization to ensure timely completion of proper and successful implementation.

o Respond to compliance violation allegations and initiate and oversee investigations.

Assist in the creation and implementation of a Compliance Auditing and Monitoring function to support the execution of audit plans across the Company, an Oversight of Regulatory Change function to validate proper implementation of regulatory changes within defined timelines, and a Delegated Vendor Oversight function that oversees business monitoring of compliance metrics for delegated entities.

o Regularly review KPIs and metrics monitoring compliance and regulatory performance and provide reports as directed or requested to the Chief Risk Officer and other senior leadership and/or committees regarding the operations and progress of compliance efforts.

Leads submission for annual Ethisphere Worlds Most Ethical Companies designation.

Responsible for overseeing the strategic and the day-to-day activities of the Compliance department, including directing, coaching, and guiding associates to implement departmental, divisional, and organizational mission/goals.

o Recruits, retains and develops a high performing team for the Compliance department.

o Evaluates performance of team member, generates development plans and sets goals within the context of the corporate policies and procedures.

o Develops annual goals, and prepares, monitors, and analyzes variances of departmental budgets to control and appropriately allocate resources.

SUPERVISORY RESPONSIBILITY:

Manages a team of approximately 30-40 people

QUALIFICATIONS:

Education Level: Bachelor's Degree.

Experience: 12 years progressive experience in compliance, audit, and risk roles with significant focus on compliance and 5+ years in a leadership position, with a minimum of five years in healthcare.

Preferred Qualifications : Juris Doctor, or Masters Degree, or other advanced degree, or a certificate in health compliance is highly preferred.

Knowledge, Skills and Abilities (KSAs)

• Broad experience planning, developing, implementing, monitoring, and managing compliance programs.

• Knowledge of laws, rules, and regulations regarding healthcare billing, delivery, and operations.

• Familiarity with operational, financial, quality assurance, and human resource procedures and regulations.

• Experience in state and federal regulatory oversight (i.e., CMS).

• Experience working with senior management and board members is preferred.

• Strong critical thinking skills and the ability to manage ambiguity, make judgement calls, and deal with difficult issues in a balanced, professional, assertive, analytical, and proactive manner.

• Excellent organizational, written, verbal, and presentation skills, including the ability to interpret, influence, and communicate guidance internally and to effectively communicate with carriers and regulators.

• Established track record for developing talent, cultivating team culture, managing people and projects, and leading within and across organizations with the ability to lead and motivate teams.

• Collaborative by nature and able to build strong partnerships.

• Comfortable in a fast-paced environment and ability to manage and prioritize a diverse and complex workload. Ability to influence beyond authority in a complex and matrixed organization.

• Excellent analytical and problem-solving abilities, with a data-driven approach to identify and mitigate compliance risks.

• Demonstrable ability to drive enterprise-wide policies and practices leveraging compliance expertise with deep understanding of compliance laws, regulations, and frameworks.

• Demonstrated commitment to ethical conduct, integrity, and the ability to uphold confidentiality principles.

• Knowledge of the industry and emerging trends, technologies, and best practices related to compliance.

Salary Range: $236,960 - $355,440

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Corporate Compliance Office

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.

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REQNUMBER: 19793