Director of Compliance

Full-Time / New York, NY

Lighthouse Guild is the leading not-for profit vision and healthcare organization with a longstanding heritage of addressing the needs of people who are blind or visually impaired. By integrating vision and healthcare services and expanding access through education and awareness, we help people lead productive, dignified and fulfilling lives.

Reporting to the Chief Compliance Officer, you will play an integral role in the oversight and management of Medicare and Medicaid regulatory compliance activities, including identification and development of policies, procedures and protocols that support regulatory and contractual requirements governing all managed care lines of business.

Responsibilities include:

  • Developing, initiating, maintaining and revising policies and procedures for the general operation of the Plan’s compliance program and its’ related activities for all Lines of Business (LOB’s).
  • Conducting and ensuring completion of annual Plan risk assessment to identify areas with potential compliance issues.
  • Developing the annual Compliance Work Plan and overseeing completion of projects identified within the Work Plan.
  • Updating Compliance Program description as required and assuring annual review and approval by the Compliance Committee.
  • Investigating or referring to Special Investigations Unit (SIU) potential Fraud, Waste and Abuse cases and reporting findings to the Chief Compliance Officer and Plan senior staff as appropriate.
  • Maintaining reporting calendar and assuring required submissions are made in a timely manner.
  • Reviewing and tracking all HPMS, NYSDOH and other regulatory memos, identifying operational changes to be implemented, and communicating requirements to affected departments.
  • Tracking compliance with regulatory changes by reviewing policies and work flows.
  • Assisting in the identification and resolution of operational challenges and issues.
  • Identifying non-compliant activity and managing resolution including the development of plans of correction with involved departments.
  • Ensuring proper reporting of violations or potential violations to duly authorized enforcement agencies as appropriate and/or required.
  • Facilitating the completion of required CMS and NYS DOH filings, including but not limited to, required attestations and Part C & D reporting.
  • Coordinating and leading the GuildNet Compliance Committee; preparing and disseminating agenda and materials.
  • Reviewing monitoring reports on a regular basis and preparing summary reports for senior leadership.
  • Conducting and/or overseeing internal and delegated audits as needed and preparing reports.
  • Reviewing member materials for regulatory compliance prior to submission to CMS or NYS.
  • Collaborating with the Staff Development department and acting as a subject matter expert for Medicare and Medicaid regulatory issues.
  • Arranging outside audit of Compliance Program as required by regulation.
  • Participating in Auditing and monitoring functions of downstream entities.
  • Serving as a member of the Delegation Oversight Committee.
  • Serving as a liaison to the Special Investigations Unit (SIU).
  • Maintaining privacy of patient, client or protected member health information.
  • Performing other related functions as assigned.

To qualify, you must have a Bachelor’s Degree (Master’s preferred), along with 5 years of managed care or regulatory compliance experience. Excellent leadership, analytical, problem-solving, oral/written communication and interpersonal skills will be expected, as will PC proficiency.

We offer competitive salary and a comprehensive salary benefit package. For consideration, please apply with your resume with desired salary.