VP Compliance, Health Plan

About Us

Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well.

Our Core Values are:

• We serve faithfully by doing what's right with a joyful heart.
• We never settle by constantly striving for better.
• We are in it together by supporting one another and those we serve.
• We make an impact by taking initiative and delivering exceptional experience.

Benefits

Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:

• Eligibility on day 1 for all benefits
• Dollar-for-dollar 401(k) match, up to 5%
• Immediate access to time off benefits

At Baylor Scott & White Health, your well-being is our top priority.

Note: Benefits may vary based on position type and/or level

Job Summary

Reporting to the SVP, Chief Corporate Ethics & Compliance Officer, the VP Compliance, Baylor Scott & White Health Plan is responsible for planning, developing, and maintaining the Compliance program for Baylor Scott & White Health Plan (BSWHP), which may include varied compliance functions and programs. Leads the development of the BSWHP compliance programs to prevent and detect non-conformance to laws, regulations, standards, and BSWHP policies and ensures the implementation of an effective compliance program for BSWHP. Develops and implements strategies, policies, procedures, and practices that establish BSWHP standards for compliance. Ensures compliance with all applicable laws, regulations, and accreditation standards, such as the Joint Commission, Centers for Medicare and Medicaid (CMS), National Committee for Quality Assurance (NCQA), Health Insurance Portability and Accountability Act (HIPAA), and Occupational Safety and Health Administration (OSHA). Responds and reacts to changes and developments in laws or the regulatory environment that might affect BSWHP compliance and implements necessary changes. Investigates, audits, and resolves alleged violations or incidents of nonconformance and verifies that compliance deficiencies have been corrected. Provides key support and regular reporting to the BSWHP Finance Audit and Compliance Committee of the BSWHP Board. May develop and implement employee compliance training curriculum. Collaborates closely with executive leadership, operations, legal, risk management, finance, and Information Security to identify and resolve compliance issues in accordance with overall BSWHP business objectives.

An entity Vice President (VP) develops strategy and business plans for one or more business units. Business unit may include a level of smaller entity vice presidents (e.g., small hospitals, clinics, etc.). Leads strategy execution, identifies resourcing needs, and provides guidance for significant tactical decisions. Focuses on current-year operations and participates in establishing multi-year strategies and business plans. Erroneous decisions at this level tend to have a long-term negative effect on the success of the organization. Leads and directs a single business unit or region. Typically directs multiple levels of subordinate directors and/or managers covering varied disciplines and skill levels. Has managerial accountability for staffing and budgets for a large span of control (at least 2 managers/directors). Exercises wide latitude in determining objectives and approaches to critical assignments. Responsible for executing a portion of the business strategy.

This role could potentially be based in Temple or Dallas, Texas.

Essential Functions

- Oversees the compliance function of the health plan for BSWH.
- Sets the strategic plan and priorities for health plan compliance and leads compliance audits, investigations, and corrective action planning.
- Ensures that the compliance program meets all applicable regulatory requirements of government regulatory entities, including the Health and Human Services Commission (HHSC), Office of Inspector General (OIG), the Centers for Medicare and Medicaid Services (CMS), and the Texas Department of Insurance (TDI).
- Leads ethics and integrity initiatives, including the review, update, and dissemination of the code of conduct and partners with the system compliance program as it relates to the conflicts of interest program.
- Oversees the annual review, revision, and communication of compliance policies and procedures of all legal, regulatory, and accreditation requirements.
- Leads the development and delivery of appropriate compliance education and training programs for employees, network providers, and leadership.
- Organizes and leads the health plan compliance committees, including development of appropriate agendas, reporting, and related information.
- Oversees the development and implementation of anti-fraud program, including the coordination of internal investigations, anti-retaliation controls, reporting of violations as appropriate.
- Conducts annual risk assessments and prioritizes the identified risks for inclusion in the annual compliance auditing work plan.
- Leads the development and implementation of dashboards, metrics, and plans to monitor compliance performance and identify corrective action plans.

Key Success Factors

- Bachelor's degree in healthcare administration, business, or related field preferred. Master' s degree preferred.
- 5+ years of compliance experience with complex regulatory environments, preferably for a health plan or a large-scale, multi-facility healthcare system.
- 3+ years of experience in a leadership role.
- Experience developing, scaling, and leading a health plan compliance program.
- Strong working knowledge of healthcare compliance practices, ethics, and regulatory requirements.
- Experience conducting healthcare compliance investigations and addressing non-compliance.
- Healthcare compliance professional certification preferred, such as Certified in Healthcare Compliance (CHC), Certified Information Privacy Professional (CHPC), Certified Healthcare Research Professional (CHRC), and Certified Healthcare Compliance Fellow (CHC-F).
- Excellent written, verbal, and presentation skills.

Belonging Statement

We believe that all people should feel welcomed, valued and supported, and that our workforce should be reflective of the communities we serve.

QUALIFICATIONS

• EDUCATION - Bachelor's
• EXPERIENCE - 5 Years of Experience