Senior Director, Compliance and Delegation

Job Description
The Senior Director, Compliance and Delegation, is responsible for leading a variety of enterprise-wide compliance functions for a publicly-traded health care technology company, to include the Corporate Compliance Program, the Vendor Oversight Program, operational compliance, delegation, auditing and monitoring, and other healthcare industry compliance activities. This role will also advise and direct on federal and state compliance requirements related to government health care benefits programs, including Medicare, Medicaid and commercial insurance markets. Duties and Responsibilities:

• Oversee and direct the day-to-day operations of the Corporate Compliance Program, which includes conducting internal audits, managing external audits, assessing and mitigating compliance risk, and navigating compliance requirements that impact business, products, operations and systems across the enterprise;
• Oversee and direct the day-to-day operations of the Vendor Oversight... Program and all aspects of regulatory vendor and delegation management for business partners, which includes managing policy reviews, leadership of all vendor oversight functions; ensuring vendors contractual compliance; and assuring compliance with Centers for Medicare and Medicaid Services (CMS), state Medicaid and insurance department regulations, National Committee for Quality Assurance (NCQA) standards and other relevant guidance;
• Lead compliance activities associated with the companys subcontracted clinical vendors (e.g., nursing professional corporations, retail clinics, clinical laboratories, transportation companies), and client-delegated credentialing functions;
• Serve as the company's subject matter expert for operational compliance matters for both internal and external stakeholders (e.g., counsel business leaders on compliance approach, regulatory considerations relating to new product development/expansion and other considerations in support of business objectives);
• Oversee the coordination and implementation of client corrective action plans for compliance, regulatory and delegated areas;
• Lead and guide a multi-disciplinary compliance and delegation team;
• Maintain compliance with Inovalons policies, procedures and mission statement;
• Adhere to all confidentiality and HIPAA requirements as outlined within Inovalons Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position; and
• Fulfill those responsibilities and/or duties that may be reasonably provided by Inovalon for the purpose of achieving operational and financial success of the Employer. Job Requirements:
• Minimum of ten (10) years of prior compliance experience which should include a combination of regulatory compliance, managed care, risk assessment and audit experience;
• Minimum of five (5) years of prior experience managing teams and direct reports;
• Significant experience in a compliance role at a health plan and/or in a managed care environment or at a technology and service vendor that contracts with health plans;
• Knowledge of and direct experience with CMS, Medicaid and other relevant federal and state regulatory and accreditation (e.g., NCQA) requirements;
• Experience with monitoring and ensuring compliance with federal and state regulatory requirements and experience in interpreting state and federal laws;
• Demonstrated effectiveness operating in complex organizational and regulatory environments;
• Must excel in fast-paced environment with multiple service locations and a broad set of diverse stakeholders;
• Effective verbal and written communication skills and interpersonal skills with the ability to effectively listen and communicate to varied levels;
• Ability to independently manage, set priorities, execute effectively and pivot as appropriate; and
• Strong problem solving, risk analysis, and project management skills and the ability to work with minimal supervision. Preferred Knowledge and Experience:
• Experience with, or the ability to learn, the operational compliance requirements of nursing practices and clinical laboratories (e.g., state professional licensing, the corporate practice of medicine, telemedicine, CLIA); and
• Knowledge of and direct experience with federal and state fraud, waste and abuse laws (e.g., False Claims Act, Anti-Kickback Statute); Education:
• Bachelors Degree or equivalent work experience required; and
• Compliance-related certification a plus. Physical Demands and Work Environment:
• Sedentary work (i.e. sitting for long periods of time);
• Exerting up to 10 pounds of force occasionally and/or negligible amount of force;
• Frequently or constantly to lift, carry push, pull or otherwise move objects and repetitive motions;
• Subject to inside environmental conditions; and
• Travel for this position will be 15% or less. This position will sit in the corporate Bowie location. This position will be a hybrid role working remotely and in the Bowie office on a weekly basis. CHJ21 By embracing diversity, equity and inclusion we enhance our work environment and drive business success. Inovalon strives to reflect the diversity of the communities where we operate and of our clients and everyone whom we serve. We endeavor to create a culture of inclusion in which our associates feel empowered to bring their full, authentic selves to work and pursue their professional goals in an equitable setting. We understand that by fostering this type of culture, and welcoming different perspectives, we generate innovation and growth. Inovalon is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status. We also consider qualified applicants regardless of criminal histories, consistent with legal requirement. The Company maintains a drug free work environment for all of its associates, which includes employees, contractors and vendors. It is unlawful for associates to manufacture, sell, distribute, dispense, possess or use any controlled substance or marijuana in the workplace and doing so will result in disciplinary action, up to and including termination of employment or the contracted relationship. Consistent with Inovalons safety protocols, the company will require a vaccination attestation for fully office-based and hybrid (office/remote) positions. Positions designated as fully remote are exempt from the attestation requirement unless and until such time as an in-office presence is required.

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