Compliance Officer Oklahoma State Medicaid

$120,000 - $140,000/Yr

Liberty Dental Plan - Oklahoma City, OK

Full-time - Senior

Oklahoma City, OK

Insurance Carriers and Related Activities

About the position

The Compliance Officer for Oklahoma State Medicaid at LIBERTY Dental Plan is responsible for ensuring adherence to all relevant state and federal regulations. This role involves developing, implementing, and monitoring compliance programs specific to Medicaid dental insurance services, collaborating with internal teams and external agencies to manage risks, and implementing corrective actions as necessary. The position requires a strong understanding of Medicaid laws and regulations, particularly those applicable in Oklahoma, and involves significant interaction with regulatory bodies and internal stakeholders.

Responsibilities

• Ensure compliance with all Oklahoma state Medicaid regulations, including the Department of Health Care Services (DHCS) and other applicable government agencies.
• Develop, implement, and monitor compliance programs specific to Medicaid dental insurance services.
• Collaborate with Corporate Compliance on audits and regulatory reviews, ensuring preparedness and addressing findings effectively.
• Establish and enforce standards and procedures to prevent, detect, and correct improper or illegal conduct.
• Collaborate with the legal and operations teams to assess and mitigate compliance risks related to Medicaid contracts and services.
• Serve as the point of contact for all compliance-related issues and inquiries regarding Medicaid dental insurance business.
• Conduct training programs to educate staff on compliance-related matters, ensuring alignment with Medicaid requirements.
• Investigate compliance issues and work with internal teams to resolve them in a timely manner.
• Prepare and submit required reports to regulatory bodies and Medicaid authorities as needed.
• Maintain knowledge of industry trends and best practices related to compliance in the Medicaid dental insurance space.
• Develop corrective action plans and ensure compliance with Oklahoma state and federal guidelines during implementation.
• Monitor Oklahoma state Medicaid Policies and Procedures (P&P) to ensure compliance with the Oklahoma state Medicaid contract.
• Monitor and track high risk compliance issues which may expose LIBERTY to sanctions, penalties, liquidated damages, Corrective Action Plans (CAPs), and/or fines.
• Monitor all Medicaid contractual commitments to ensure contractual obligations are met.
• Oversee the onboarding and monitoring of all approved Medicaid subcontractors/vendors by National Compliance.
• Collaborate with National Compliance regarding the responses to regulatory inquiries and regulatory audits which involve the Medicaid contract.
• Track new requirements specific to the Medicaid Contract and provide guidance to business owners on existing and new Oklahoma state Medicaid requirements.
• Collaborate with Corporate Compliance to investigate HIPAA, Privacy, and Security issues related to the Oklahoma Medicaid Contract.
• Attend regulatory meetings as needed.

Requirements

• Bachelor's degree in Healthcare Administration, Law, Business, or a related field; Graduate degree preferred.
• Minimum 6 years' experience in compliance roles, with a focus on Medicaid programs within the dental or healthcare insurance industry.
• Certification in healthcare compliance (CHC) or Certified Compliance and Ethics Professional (CCEP) preferred.
• Comprehensive knowledge of Medicaid laws, regulations, and state-specific requirements.
• Experience managing audits and regulatory reviews related to Medicaid services.
• Excellent communication skills, with the ability to collaborate effectively across departments.
• Strong problem-solving and analytical skills to handle complex compliance challenges.
• Detailed knowledge of Medicaid program requirements, particularly DHCS, CMS, and other relevant Nevada state regulations.
• Strong ability to assess compliance risks and propose mitigation strategies.
• Excellent organizational skills and the ability to manage multiple priorities in a fast-paced environment.
• Proficient in compliance-related reporting and documentation.
• Leadership abilities to guide compliance efforts and foster a culture of adherence to regulations.

Benefits

• Wellness program
• AD&D insurance
• Paid holidays
• Disability insurance
• Health insurance
• Dental insurance
• 401(k)
• Tuition reimbursement
• Dependent health insurance coverage
• Employee assistance program
• Vision insurance
• 401(k) matching
• Gym membership