Job Description

POSITION SUMMARY/RESPONSIBILITIES
Ensures Community First compliance with governmental regulations and major commercial and governmental contracts. Coordinates governmental filings for new product development and new venture development projects. Ensures compliance with the Business Risk Management Plan. Interprets governmental regulations and statutes and provides oversight to the development, implementation, and enforcement of Community First policies and procedures. Oversees Community First’s Compliance Program and reviews and evaluates compliance issues and concerns within the organization. Ensures compliance with governmental regulations, including the Texas Department of Insurance (TDI), the Texas Health and Human Services Commission (HHSC), and the Centers for Medicare and Medicaid Services (CMS), policies and procedures specific to those programs and expectations, and regulatory requirements.

EDUCATION/EXPERIENCE
A Bachelor’s degree in Health Care Administration, Business Administration or a related field is required. A Master’s degree in Health Care or Business Management is preferred. Must have a minimum of five years’ experience in business development, including at least three years in contract compliance, preferably in a managed care administrative setting. Knowledge of Texas Medicaid (STAR, STAR Kids, STAR+PLUS), and CHIP regulations, HHSC, and TDI regulations required. Knowledge of Medicare Advantage and Medicare Dual Special Needs Plan is preferred. Strong experience developing and implementing high-quality standards, auditing procedures, healthcare regulations, policy formulation, and process improvement principles is required.

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