Health Net, Inc.
Position Purpose: Manage and implement strategies to ensure successful maintenance and implementation of compliance programs that meet regulatory requirements for assigned products across the entire companyEnsure all Medicare and Medicaid product and services are being tested for compliance with program regulations, insurance regulations, and regulatory requirements for business entities
Maintain and track laws and regulations, contract documentations, amendments, and various compliance measures
Develop policies, procedures, and process to comply with federal program regulations, and any applicable state regulations
Provide guidance to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language
Conduct compliance audits, develop and implement corrective action plans
Perform plan risk assessments and report emerging trends, deficiencies and variances; report findings to other departments and teams as appropriate
Provide required Ethics, Compliance, Risk Management, FWA, privacy, and security training for existing and new employees and as required non-employees
Provide mentoring and guidance to subordinates within the department as necessary
Serve as primary backup to department lead as necessaryCommercial Insurance (additional responsibilities):
Monitor Commercial product risks in accordance with the risk reporting policies
Manage Benefit Filings and entity licensures for all products to ensure compliance with state and federal regulatory requirements
Work in collaboration with Marketing teams to monitor Sales & Marketing representatives and materials used in advertisementsMedicare (additional responsibilities):
Monitor the FDR oversight program to ensure all Medicare and MMP plans are conducting the appropriate oversight in a timely manner
Report all Medicare and Medicaid product risks in accordance with the risk reporting policies
Partner with various departments as the local executive responsible for ensuring that state and/or federal regulatory requirements relating to business continuity and disaster recovery are communicated and met
Health Net, Inc.
Website : https://www.healthnet.com
Health Net's mission is to help people be healthy, secure and comfortable.