Lisa Knowles Email & Phone Number

New Jersey, United States

Foster a culture of legal and ethical business conduct in the market. Lead an ongoing assessment of the Compliance Program in the market ensuring that the Compliance Program meets all standards and requirements. Identify, escalate, and oversee remediation efforts of business practices that may be inconsistent with federal, state, local laws and regulations and/or contractual requirements. Work collaboratively with the Market leadership and other functional business areas in developing business-oriented solutions for complex compliance and business problems to reduce risk. Monitor contractual requirements, the submission of required regulatory reports, health care compliance issues, trends and benchmarks.

Newark, Nj

Leads the State Regulatory Affairs department. Responsible for developing and executing the Medicaid Regulatory Affairs strategy focused on publicly funded healthcare programs. Provides guidance, oversight and supports Regulatory Affairs teams with respect to contract administration and account management. Key duties and responsibilities include but are not limited to; manage risk and execute resolutions through expertise and lessons learned.Establishes the Medicaid Regulatory Affairs strategy and oversees contract administration activities in markets. Manages and supports audits and implementations to ensure regulatory requirements are satisfied. In partnership with Corporate Compliance, develops procedures, toolkits and reports and monitors contractually required deliverables, including but not limited to, regulatory reports and performance metrics. Develops procedures and toolkits for Account Management Plans and monitors adherence with corporate processes. Directs and manages a team of associates responsible for supporting Medicaid Regulatory Affairs initiatives and teams. Supports development and implementation of Regulatory Affairs in new markets. Develops and manages department budget.

Newark, Nj

Responsible for assisting the Chief Compliance Officer to implement and monitor the policies, procedures, and practices designed to ensure compliance with the requirements set forth in the Corporate Integrity Agreement (CIA) and applicable Plan contracts with Medicare, Medicaid, and Federal health care program requirements. Make periodic written reports regarding compliance matters directly to the Chief Compliance Officer. Provide assistance and operational oversight of external audits including: risk assessment, external audit management, preparation and facilitation. Monitoring and oversight of vendors as needed to ensure compliance. Work as a liaison with the Compliance Special Investigation teams, including conducting investigations relative to agent Sales & Marketing and enrollment FWA cases and conducting interviews with potential beneficiaries, members, agents, providers, associates and/or downstream entities as required for investigatory purposes. Conduct and track on-site compliance trainings and updates to the field organization. Local subject matter expert for HIPAA and responsible for local oversight of HIPAA requirements. Local contact for the Records Information Management department. Assist in training and oversight as needed. Serves as the local internal information security consultant to the organization, documenting and implementing security policies and procedures in consultation with the Chief Privacy officer and Chief Compliance Officer. Monitors compliance with Information Security policies and procedures.

Newark, Nj