What are the responsibilities and job description for the Compliance Director position at XO Health Inc.?
XO Health believes healthcare is fixable. Become part of the community changing the face of the industry.
XO Health is the first health plan designed by and for self-insured employers that delivers a more unified health experience for everyone – from those who receive care, to those who deliver it, to those who pay for it.
We are growing a multi-disciplinary team of diverse and digitally empowered employees ready to rebuild trust in healthcare through comprehensive and unified transformation.
About the Role:
The Compliance Director will lead and direct XO Health's Compliance Program, ensuring that the organization operates in full compliance with applicable state and federal regulations, licensure requirements, and NCQA (National Committee for Quality Assurance) and URAC (Utilization Review Accreditation Commission) standards. This position plays a pivotal role in maintaining the organization's legal and regulatory integrity, overseeing licensure processes across all jurisdictions, and facilitating successful NCQA and URAC accreditation. The Compliance Director will collaborate closely with cross-functional teams to implement policies and practices that uphold the highest standards of compliance and quality in the provision of healthcare services.
Responsibilities include:
Licensure Compliance:
- Monitor, interpret, and communicate changes in state and federal regulations related to TPAs.
- Oversee the licensure application and renewal processes, ensuring timely submission and adherence to regulatory requirements.
- Maintain a comprehensive understanding of state-specific licensing requirements and work with legal counsel to address any compliance issues.
NCQA/URAC Accreditation:
- Lead the preparation and submission of documents required for NCQA and URAC accreditation.
- Coordinate internal efforts to meet NCQA and URAC standards, collaborating with various departments to implement necessary policies and procedures.
- Serve as the primary contact for URAC and NCQA surveyors, facilitating site visits, interviews, and document reviews.
Compliance Monitoring:
- Develop and implement a robust compliance monitoring program to identify and address potential compliance risks.
- Conduct regular internal audits and assessments to ensure adherence to licensure requirements and URAC standards.
- Collaborate with operational teams to address identified compliance issues, providing guidance on process improvement, operational excellence, root cause analysis, and corrective actions.
- Ensure that the Compliance Program can prevent and detect significant instances or patterns of illegal, unethical, or improper conduct by employees, brokers, providers, or others working with the organization.
Policy Development:
- Develop, update, and maintain policies and procedures related to licensure and NCQA and URAC accreditation.
- Ensure that policies are aligned with regulatory requirements and industry best practices.
- Educate staff on compliance policies and provide training programs as needed.
Documentation and Reporting:
- Maintain accurate and organized records related to licensure, NCQA and URAC accreditation, and compliance activities.
- Prepare and submit timely reports to regulatory agencies and internal stakeholders.
- Analyze compliance data to identify trends, proactively addressing potential issues.
- Establish, maintain and supplement as necessary a company compliance manual.
Stakeholder Collaboration:
- Collaborate with legal counsel, government affairs, regulatory agencies, and external consultants to stay abreast of changes in regulations and accreditation standards.
- Coordinate, as appropriate, with legal counsel, conducting, or authorizing and overseeing investigations of matters that merit investigation under the Compliance Program
- Foster positive relationships with regulatory authorities and serve as the organization's representative in compliance-related matters.
- Chairs the Compliance Committee, including developing appropriate agendas, reports and information as directed by the committee.
Experience and Education Required:
- Bachelor's degree in healthcare administration, business, or a related field.
- Minimum of 10 years' experience, including 3-5 years of Compliance experience, in personnel management and compliance related activities, legislative and regulatory activities, health insurance operations or legal research or equivalent combination of education and experience.
- Demonstrated knowledge and experience in healthcare compliance, licensure, and accreditation, specifically with TPAs, NCQA, and URAC standards.
- Understanding of health policy issues related to healthcare activities.
- Demonstrated ability to create a long-term vision and manage a team and function to that vision.
- Demonstrated ability to partner effectively with others in the handling complex issues.
- Strong knowledge of state and federal regulations governing TPAs and healthcare services.
- Proven track record of successful URAC accreditation for TPAs.
- Strong knowledge of compliance program element expectations from the DOJ, HHS OIG, and CMS.
- Exceptional analytical and problem-solving skills with acute attention to detail and experience improving the resiliency of operational processes.
- Excellent communication and interpersonal skills, with the ability to work collaboratively across departments.
- Ability to effectively manage multiple priorities and deadlines in a dynamic environment.
- Certification in Healthcare Compliance (CHC), Certified in Healthcare Privacy Compliance (CHPC), Certified Internal Auditor, or other relevant certification is a plus.
XO Health is an equal opportunity employer committed to diversity and inclusion in the workplace. All qualified applicants will receive consideration for employment without regard to sex (including pregnancy, childbirth or related medical conditions), race, color, age, national origin, religion, disability, genetic information, marital status, sexual orientation, gender identity, gender reassignment, citizenship, immigration status, protected veteran status, or any other basis prohibited under applicable federal, state or local law. XO Health promotes a drug-free workplace.