Job Description

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

* Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

* Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

* Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

* Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

Skills / Requirements

JOB SUMMARY: As a key member of the Executive Leadership team, the Chief Compliance Officer reports to the CEO and assumes a strategic role in the overall facilitation of the organization's Compliance Program.  The CCO has responsibility for strategic planning and operational leadership pertaining to compliance and regulatory issues as well as oversight of the enterprise wide comprehensive compliance program that includes STAR, CHIP, Marketplace, DSNP, and Medicare Programs that exceed the regulatory agencies requirements.  This includes direct responsibility for compliance, audit, fraud waste and abuse programs, accreditation, and the Company's Special Investigative Unit (SIU). Serves as the HIPAA Privacy Officer and oversees Community's HIPAA Privacy Compliance programs, including related reports and activities. Represents Community at HHSC, TDI, and other meetings as needed and responsible for communicating information back to Community leadership and staff.  Assures the Compliance Department serves as the Single Source of Truth (SSOT) for all Compliance-related data, programs, and corrective actions. Responsible for Community's health policy interpretation and communication to business owners; certifications and licensures. Oversees collaboration with other leaders and departments to assure Compliance requirements and organizational objectives and targets are successfully achieved. The CCO is responsible for maintaining NCQA and/or URAC accreditation and any other accreditations required by Community.


QUALIFICATIONS:

1. Education/Specialized Training/Licensure: Bachelor¿s Degree required.
Master¿s degree or JD preferred. CCEP, CHC or other Compliance Training/Certification(s) strongly preferred, or alternatively, commitment to and ability to achieve certification within 6 months of employment.
2. Work Experience (Years and Area): Ten years of compliance experience with at least 5 years in senior management required.  Experience with managed care, state regulatory agencies, DOI, and CMS regulations are required.
3. Management Experience (Years and Area): Six years supervisory/management experience required.
4. Software Operated: Microsoft Office (Word, Excel, Outlook)

OTHER REQUIREMENTS:

Experience developing and implementing strategies and objectives for the organization as a member of Executive Leadership, as well as developing and implementing strategies and objectives for assigned areas of oversight.

Skilled at developing, implementing and reporting regarding Compliance programs, initiatives, and successes/failures.  Ability to justify and explain areas of non-compliance and corrective action plans to stakeholders.

Demonstrated ability to proactively identify and analyze the root cause of non-compliance, or challenges and concerns achieving compliance, as well as ability to develop and implement solutions

Excellent communication skills, including effective communication of Compliance strategies, initiatives and corrective action plans to the Board of Directors, Executive Leadership and external stakeholders, including regulatory agencies.

Experience managing compliance/FWA reporting programs and software (e.g. NAVEX).

Demonstrated ability to quickly adapt to new situations and challenges.

Skilled at delegation, management and development of staff.

Ability to inspire confidence and build trust.

SPECIAL REQUIREMENTS: (Check Applicable Areas)

1. Communication Skills:
Above Average Verbal (Heavy Public Contact)
Exceptional Verbal (e.g., Public Speaking)
Writing /Composing:  Correspondence / Reports

2. Other Skills: Analytical, Mathematics, Medical Terminology, Research, Statistical,
MS Word,MS Excel

3. Advanced Education:
Bachelor's Degree Major: BA/BS
Master's Degree Major: Preferred
Doctorate Major: JD or Master's preferred

4. Work Schedule: Flexible

5. Other Requirements:
Knowledge of Medicaid, Medicare and individual insurance regulations and compliance requirements.  Familiarity with HIPAA regulations.   Ability to organize task and work independently as well as lead a team and collaborate within and outside of Community.  Strong attention to detail and deadlines.  Team leader abilities to encourage interdepartmental cooperation and interest. Demonstrate familiarity with physician and hospital coding and billing.

RESPONSIBLE TO: CEO

EMPLOYEE SUPERVISED: Professional and Clerical Staff

Application Instructions

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