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 benefitsDollar-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

VP Coverage Compliance is responsible for planning, developing, and enforcing compliance programs for Baylor Scott and White Health (BSWH) and specifically for the Baylor Scott and White Health Plan (BWSHP) and Baylor Scott and White Quality Alliance (QA), collectively known as the “Coverage” system. This includes Health Plan and QA compliance and in partnership with the system to provide compliance hotline services, conflicts of interest, education, communications, and other compliance activities. The VP Coverage Compliance leads the development of compliance programs to prevent and detect non-conformance to laws, regulations, standards, and BSWH policies and ensures the implementation of a compliance program for assigned area of the organization. The leader develops and implements strategies, policies, procedures, and practices that establish BSWH standards for compliance and ensures compliance to 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). The leader anticipates, responds and reacts to changes and developments in laws or the regulatory environment that might affect BSWH compliance and implements necessary changes. The leader investigates, audits, and remediates alleged violations or incidents of nonconformance and verifies that compliance deficiencies have been corrected. The leader provides key support and regular reporting to the Audit and Compliance Committee of the BSWHP and QA Boards.. The leader may develop and implement employee compliance training curriculum. The leader collaborates closely with leaders with the Coverage business unit as well as executive leadership, operations, legal, risk management, finance, and Information Security to identify and resolve compliance issues in accordance with overall BSWH business objectives.

Essential Functions

- Sets the strategic plan and priorities for Coverage Compliance system and oversees the Coverage Compliance system for BSWH. 
- Ensures 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).
- Manages and oversees the Health Plan NCQA accreditation process and the NCQA accreditation process for Coverage care management.
- Leads ethics and integrity initiatives, including the review, update, and dissemination of the code of conduct and conflict of interest programs.
- Oversees the annual review, revision, and communication of Coverage compliance policies and procedures of all legal, regulatory, and accreditation requirements.
- Leads the development, delivery, and tracking of appropriate compliance education and training programs for employees, network providers, and leadership.
- Organizes and leads the Coverage Compliance Committees, including development of appropriate agendas, reporting, and related information and is an active member of the Coverage leadership team in reporting updates and critical matters to the various boards.
- 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 assessment across the Coverage team, prioritizes the identified risks for inclusion in the annual compliance auditing and monitoring work plan.
- .Leads the development and implementation of metrics and dashboards related to the auditing and monitoring work plan and works closely and compatibly with business leaders in remediating issues, including corrective action plans.
- Is an active and visible member of the Coverage system leadership team.

Key Success Factors

- Bachelor’s degree required; Master’s degree in healthcare administration, business, or related field preferred. 
- Ten years of compliance experience within a complex regulatory environment, preferably for a health plan, managed care company or a large-scale, multi-facility healthcare system.
- Ten years of experience in a leadership role with budget and performance management responsibilities; Experience having led a start-up, turn-around, realignment or another experience leading through change
- Experience developing, scaling, and leading an enterprise-wide compliance program with clear metrics and measures of success; Able to “get things done”
- Strong working knowledge of healthcare compliance practices, ethics, and regulatory requirements.
- Experience conducting healthcare compliance investigations and addressing non¬compliance in a productive, business-friendly manner
- 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; Experienced in board-level communications and other executive presentations
- Ability to assimilate and effectively lead in the context of the BSWH mission, vision and values

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.

Minimum Requirements
- Bachelor’s Degree
- 10 years of experience