Director of Compliance – Medicaid (OK) Job in Oklahoma City, OK at MRI


MRI Oklahoma City, OK


This position will direct and provide leadership to the Oklahoma Medicaid (SoonerCare) Compliance team. The key performance initiatives include the following: project management, risk analysis, vendor management, internal auditing, creating and reviewing Oklahoma Medicaid reports, HIPAA disclosures, FWA activities, drafting and responding to internal and external Corrective Action Plans, and interacting with the Oklahoma Health Care Authority (OHCA).

Essential Duties:

  • Oversee development and implementation of all approved Oklahoma Medicaid Policies and Procedures to ensure compliance with the Oklahoma Medicaid Contract;
  • Oversee complex project management tasks which involve high risk compliance issues which may expose LIBERTY to litigation and/or sanctions, penalties, liquidated damages, and/or fines;
  • Oversee internal workgroups to resolve and mitigate potential risks;
  • Oversee tracking and monitoring of all Oklahoma Medicaid contractual commitments to ensure contractual obligations are met;
  • Oversee drafting and responses to internal and external Corrective Action Plans which identify potential areas of non compliance and demonstrate resolution of any identified deficiency;
  • Oversee the onboarding and monitoring of all approved Oklahoma Medicaid subcontractors/vendors by National Compliance;
  • Oversee the responses to regulatory inquiries and regulatory audits which involve the Oklahoma Medicaid contract;
  • Ensure tracking of new requirements specific to the Oklahoma Medicaid Contract and provide guidance to business owners on existing and new Oklahoma Medicaid requirements;
  • Work with Corporate Compliance to investigate HIPAA, Privacy, and Security issues related to the Oklahoma Medicaid Contract; and 
  • Attend regulatory meetings with OHCA, Medicaid Program Integrity, and the State of Oklahoma


Education and/or Experience:

  • BS/BA from a 4-year college or university – preferably in business administration, health care administration, finance, accounting, or criminal justice.
  • Minimum of 4 years’ experience as a Medicaid/Medicare Compliance Officer.
  • 5 years of healthcare/dental investigative experience in one of the following areas: Law enforcement, a juris doctorate, fraud certification, medical coding certification, or a medical professional such as a doctor, dentist, or registered nurse.

Specific Skills/Knowledge:

  • Knowledge of Medicaid contracts, legal requirements and laws, investigative and accounting procedures, data processing systems, auditing, claims processing, claims systems, medical/dental review, appeals, membership, and enrollment.
  • Knowledge of Oklahoma Medicaid Rules and Regulations.
  • Strong people skills and the ability to be resourceful, as well as to make concise, independent and defensible decisions in often high-pressure situations.
  • Strong organizational skills which allow simultaneous completion of tasks and duties while maintaining the ability to coach and develop staff.
  • Proven ability to effectively communicate orally and in writing detailed and complex information to others that possess varying degrees of comprehension.



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