Summary of role:

The Compliance Manager is responsible for ensuring compliance with all applicable laws, regulations, and contractual requirements related to the administration of self-funded health plans, a virtual primary care practice, and an affiliated captive. The Compliance Manager will work closely with internal departments, and external stakeholders including business partners, to develop, implement, and oversee the compliance program for the health plan.

Responsibilities Include:

• Assess existing compliance processes and develop and implement plans to strengthen them as necessary to ensure ongoing adherence to all applicable laws, regulations, and contractual requirements.
• Research, analyze and provide legal and regulatory guidance on business issues related to self-insured health plan administration services (traditional and ACO-type models) and stop-loss & captive insurance arrangements
• Oversee compliance with state corporate practice of medicine laws and regulations related to the virtual primary care practice, including licensing and supervision requirements.
• Conduct internal compliance audits and assessments to identify areas of risk and implement corrective actions.
• Provide guidance and training to internal departments on compliance-related matters, including HIPAA privacy and security, ERISA, No Surprises Act, Mental Health Parity, Transparency in Coverage, CAA and state corporate practice of medicine laws and regulations.
• Collaborate with external stakeholders, including regulatory agencies, auditors, and third-party vendors, to ensure compliance with all applicable requirements.
• Stay up-to-date on changes to laws, regulations, and industry standards that may impact the health plan's compliance program.

Qualifications:
Required Skills and Abilities:

• Familiarity with Department of Labor and IRS regulations relevant to TPAs and plan sponsors, including: No Surprises Act, Mental Health Parity, Transparency in Coverage, CAA, etc.
• Familiarity with HIPAA privacy and security requirements.
• Some familiarity with state corporate practice of medicine laws and regulations, reinsurance regulations, and ERISA prohibited transaction rules is preferred.
• Excellent communication and interpersonal skills with the ability to work collaboratively with internal and external stakeholders.
• Comfort working in a fast-paced environment and operating with ambiguity
• Certified in Healthcare Compliance (CHC) or other relevant certification preferred.

Education and Experience:

• Bachelor's degree in healthcare administration, business, or a related field required; master's degree preferred.
• At least six years of experience in healthcare compliance, preferably in a self-funded health plan or third-party administrator environment.

Preferred Qualifications:

• An ideal candidate would be assigned to the Buffalo Office with ability to work from home
• Fully remote candidates will still be considered for this role with possibility of travel.

Centivo Values:

• Empathy - We treat your problem as if it is our problem. Because it is. We are always glad to help because we care.
• Resourcefulness - If it needs to be done, we’ll figure it out and get it done, or make sure it gets done.
• Integrity - We do the right thing. Always. That includes placing people before profits.
• Possibility - We start with Yes.
• Reliability - We will always do what we say we will. You can count on us. Every single time.
• Teamwork & Collaboration – We treat each other with respect and listen, support and value each other’s opinions as we work toward our shared goals.