Senior Director – Compliance Advisory – Medicare

Senior Director – Compliance Advisory – Medicare

Requirements

• Bachelor’s degree Business Administration, Healthcare Administration, related field or equivalent experience required
• 10+ years Compliance, preferably in healthcare environment required
• 5+ years Medicare and/or Managed Care required
• 1+ years Overseeing implementation of contract requirements required

Responsibilities

• Oversee and monitor various cross-functional projects implemented by management
• Develop strategic relationships to assist with the development of public policy concerning federal managed care regulations and initiatives
• Represent senior management at various committees, meetings, and seminars
• Communicate with CMS ensure timely completion of CMS requirements and expectations
• Ensure all Medicare and Medicaid products and services are being tested for compliance with program regulations, insurance regulations, and regulatory requirements for business entities
• Maintain and track laws and regulations, contract documentations, amendments, and various compliance measures
• Develop policies, procedures, and processes to comply with federal program regulations, and any applicable state regulations
• Work with Operational Departments to ensure that policies, procedures, and processes are developed and modified to comply with state regulatory standards. Provide guidance to various departments with respect to regulatory and contract language
• Oversee, administer, and implement various aspects of the Medicare Compliance program
• Provide guidance to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language
• Identify, evaluate and analyze the impact of CMS and Medicare regulatory issues and advise management concerning impact
• Report all Medicare and MMP risks in accordance with the risk reporting policies
• Provide required Ethics, Compliance, Risk Management, FWA, privacy, and security training for existing and new employees and as required non-employees such as contracted temporary staff, and FDRs as needed
• Partner with various departments to ensure that state and/or federal regulatory requirements are communicated and met
• Performs other duties as assigned
• Comply with all policies and standards

Preferred Qualifications

• Master’s Degree Business Administration, Healthcare Administration or related field preferred
• 1+ years Interaction and communication with federal and state regulatory agencies preferred
• 1+ years Medicare, CMS regulations and software application tools preferred