Sr Mgr – Medicare Compliance

Sr Mgr – Medicare Compliance

Requirements

• 8 years of experience with government or compliance, or legal issues
• Bachelor’s Degree in compliance, health administration, legal studies, or other related field of study

Responsibilities

• Manage the day-to-day operations of the department.
• Control and direct workflow to staff in a timely manner, including internal and external compliance reviews / audits.
• Oversee internal, initial and final compliance review/audit reports. Maintain records of compliance investigation/audit activity and track to ensure all work papers within each investigation/review/audit are accurately controlled.
• Administer, interpret, and maintain current working knowledge of the required AZ Blue systems, procedures, forms and manuals as related to the assigned area of responsibility.
• Responsible for the review, update and accuracy of Compliance documentation, computer files, policies and procedures related to the department goals and objectives.
• Keep staff informed of new or updated standards, systems, procedures, forms and manuals through staff meetings and verbal and written communications.
• Direct, evaluate, define, and improve the quality, quantity and timeliness standards to achieve individual and department performance goals as defined within department guidelines.
• Develop and maintain competent staff to carry out assigned functions.
• Provide guidance, motivation, and encouragement to staff, conduct performance evaluations, identify and coordinate training needs, and make determinations regarding disciplinary actions.
• Plan, monitor and coordinate direct activities needed to support corporate goals and objectives.
• Evaluate and make recommendations in regard to employment decisions.
• Consult and coordinate with various internal departments, external Blue Plans or business partners and government agencies where appropriate for all Medicare compliance activities and programs as well as plans, implements and monitors the organization’s Medicare compliance program.
• Prepare and execute annual Medicare Compliance Work Plan.
• Act as a compliance liaison with the Centers for Medicare and Medicaid Services (CMS), maintaining a positive relationship with the CMS Account Manager/Regional Office.
• Prepare for and respond to CMS and other external audits.
• Manage Medicare Program requirements, such as Health Plan Management System (HPMS) submissions.
• Prepare and executive a comprehensive Medicare Compliance Program and Work Plan for the organization, including responding to all compliance questions or concerns; developing and distributing compliance training programs for the organization’s employees, and First Tier, Downstream and Related Entities (FDRs).
• Works collaboratively with Internal Audit to ensure internal controls are in place and that internal monitoring, auditing and oversight functions are being performed, and that deficiencies are fixed.
• Participate in all BCBSAZ required training, Blue Gives Back and professional seminars/training.
• Maintain compliance review tools, reports, and correspondence templates.
• Represents BCBSAZ at industry conferences and presents best practices.
• Manages projects with multi-disciplinary teams.
• Assists management of Compliance as required on other projects / tasks.
• Performs all other duties as assigned.

Preferred Qualifications

• 10 years of experience with compliance, government programs or legal issues in a healthcare industry
• Master’s Degree in business or healthcare field of study
• Advanced compliance professional, audit, or legal training