The Vice President of Government Programs Compliance is responsible for ensuring all activities of the company’s Government Programs business are conducted in accordance with applicable laws, rules, and regulations and in accordance with the company’s Code of Conduct and applicable company policies and procedures. This position is responsible for ensuring that the company conducts its business in accordance with applicable regulatory and sub-regulatory guidance, including guidance from the Centers for Medicare & Medicaid Services (CMS), the Office of Inspector General (OIG), Department of Justice, and other state and federal governmental regulatory agencies.
This position is responsible for the development, monitoring, and oversight of the comprehensive compliance plans for the Medicare (Parts B and D), Medicaid, DoD, Healthcare Reform, and other Government Programs lines of business. Further, this leader will have primary responsibility and oversight of new State Law compliance requirements and will assist with the continued implementation of the Specialty Compliance Program. This position will serve as the compliance lead contact for Government Programs audits and inquiries. In addition, this individual will serve as the Government Programs compliance liaison with operational and product areas throughout the company.
- Coordinate development and implementation of Government Programs Compliance initiatives across Express Scripts systems.
- Develop education programs for employees, as appropriate, and facilitate communication to maintain awareness of Government Programs compliance requirements.
- Regularly conduct and oversee compliance risk assessments, and auditing and monitoring efforts and refine program to address significant risks.
- Develop and implement corporate regulatory policies and procedures as needed.
- Provide compliance guidance on regulatory issues which affect the company.
- Law degree from an accredited school of law.
- Licensed to practice law in any state and eligible to obtain license in the State of Missouri.
- Minimum 12 years of health care regulatory experience with a preference for Medicare Part D, Medicare Part B, Medicaid, PBM and/or governmental heath care regulatory experience.
- J.D. required
- Certification in Healthcare Compliance preferred.
- Strong knowledge of MS Office.
- Understanding and commitment to the philosophy, mission, values and vision of Express Scripts.
- Possess Medicare expertise, with extensive prior experience interpreting and applying Medicare and Medicaid regulations as well as related regulatory and sub-regulatory and extensive experience in dealing with CMS and other state and federal government agencies.
- Possess personal and professional integrity.
- Excellent communication and presentation skills.
- Honest and highly-ethical collaborator.
- Proactive and action-oriented; strong work ethic, achievement-oriented.
- Strong people leadership skills.
- Highly effective and active communicator who works well with people at all levels.
- Strong PBM business acumen with the ability to think strategically and implement tactically.
- Compliance, audit, and management experience, including healthcare and government programs compliance.
- Demonstrated success implementing and managing compliance programs.