Sr. Director, Regulatory Compliance

HealthEdge Software Inc - Sr. Director, Regulatory Compliance - Helena, Montana

Looking for a subject matter expert in the healthcare regulatory & compliance space, with acumen and passion for leveraging innovative technology to solve critical needs in healthcare. This individual will report to the Chief Medical Officer of HealthEdge (HE) and ensure that our clinical suite of products (GuidingCare & Wellframe) support our health plan customers in achieving and maintaining compliance with the regulatory bodies that govern them: NCQA (National Committee for Quality Assurance), CMS (Centers for Medicare & Medicaid Services), URAC (Utilization Review Accreditation Commission) and other State regulatory bodies. The ideal candidate will have a strong understanding of healthcare compliance requirements across multiple regulatory bodies, as well as a deep knowledge of clinical software programs, and the ability to discern the role of the vendor in regulatory compliance.

Your Impact:

1. Proactively monitor and interpret NCQA, URAC, CMS and key state regulations in accordance with anticipated updates or revisions, providing expert impacts relevant to our customers and our software.
2. Partner with enterprise legal & compliance team to identify and document clinical regulations relevant to our HealthEdge products.
3. Collaborate with Product & Marketing stakeholders to establish clinical product positioning as it pertains to regulatory compliance.
4. Identify any areas of non-compliance in the applications, services, and processes & analyze potential risks to develop action plans when gaps are identified.
5. Develop a compliance scorecard; monitor and improve the adherence of the product portfolio to the compliance scorecard.
6. Research and track trends and developments in governmental regulations related to compliance.
7. Act as the subject matter expert and advisor on relevant legislation and regulations that apply to compliance.
8. Ensure that compliance requirements are correctly and effectively communicated to all stakeholders; create periodic regulation update briefs for internal use.
9. Communicate changes in regulations to customers in a clear and concise manner via multiple methods.
10. Ensure workflows, policies, and procedures are implemented and maintained for relevant regulatory and accreditation requirements.
11. Develop business cases and requirements for new products and enhancements that advance organizational alignment with regulatory requirements.
12. Develop and lead regulatory survey readiness planning process for relevant accreditations and certifications.

What You Bring:

1. Bachelor’s degree in a healthcare related field.
2. Legal and/or Clinical graduate-level or professional experience preferred.
3. Experience in HEDIS data and analytics are preferred.
4. Extensive experience in the healthcare industry, particularly in the Payer space.
5. 7+ years' experience with healthcare compliance/regulations – Medicare, Medicaid, federal and state requirements.
6. Advanced knowledge and in-depth understanding of NCQA, HEDIS, CMS, and State processing requirements.
7. Demonstrated ability to define & articulate business solutions to compliance issues.
8. Experience working with regulatory requirements in a software product development environment.
9. Familiarity with CMS reporting, audit requirements and audit procedures.
10. Demonstrated attention to detail.
11. Strong interpersonal, communication, organizational and coordination skills.
12. The ability to work independently, as well as part of a team.
13. Strong analytical and storytelling capabilities.

HealthEdge commits to building an environment and culture that supports the diverse representation of our teams. We aspire to have an inclusive workplace.

Geographic Responsibility: While HealthEdge is located in Burlington, MA you may live anywhere in the US.

Type of Employment: Full-time, permanent.

Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required.