Director Compliance and Medicare Compliance Officer

Blue Cross of Idaho•Bozeman, MT

1d•Hybrid

About The Position

Blue Cross of Idaho is seeking a Director of Compliance that supports and at times leads the development of compliance strategy towards achieving an effective compliance program and a culture of compliance throughout the organization. The incumbent will also act as the Medicare Compliance Officer for the organization and be the organization’s direct contact to the Centers for Medicare and Medicaid Services (CMS). The position reports to the Vice President and Chief Compliance and Ethics Officer. Hybrid or remote work schedule may be supported in a mutually agreeable location.

Requirements

10 years’ healthcare compliance experience (at least five of which should be in Medicare Advantage or Medicare Part D)
At least two years of management experience.
Bachelor’s Degree in Business Management or related field; or equivalent work experience (ten years of relevant work experience as outlined above).

Nice To Haves

Master of Business Administration (MBA), Masters of Public Administration (MPA), Masters of Healthcare Administration (MHA), Juris Doctorate (JD) or similar education.
Health insurance/managed care industry experience
Healthcare regulatory audit experience (coordinating or overseeing audits conducted by the government)
Vendor oversight process experience
HCCA or SCCE certification(s) such as Certified in Healthcare Compliance (CHC)

Responsibilities

Responsible for providing oversight and direction to compliance staff dedicated to government program (Medicare and Medicaid) compliance efforts.
Directs efforts to ensure an effective Medicare Compliance Program and creating or updating support mechanisms/processes to enable strict adherence to CMS and other state and federal government requirements.
Represents the organization in government compliance matters, audits, regulatory meetings and activities, and Board and company senior leader meetings.
Leads organizational discussions with CMS officials and CMS contracted parties (such as auditors).
Coordinates and collaborates with leadership (including senior leadership), the legal team, and other Compliance department employees and leaders in government health programs matters as well as strategic and product initiatives.
Evaluates and recommends risk mitigation strategies and key business decisions for compliance risks as well as operational, financial, strategic, and reputational risks.
Directs development of initiatives, infrastructure and resources that impact compliance program effectiveness and collaborates with other partners to mitigate compliance risk.
Advises senior leadership via the Compliance Committee of key issues, emerging risks, and risk mitigation; ensures Committee considers compliance risks in business decision-making.
Act as a co-chair of the Corporate Compliance Committee and support the Chief Compliance Officer in performing those duties.
Acts as a key adviser to the Chief Compliance and Ethics Officer.
May be asked to chair or co-chair other organizational committees or sub-committees.
Exemplifies and promotes the Company’s Code of Ethical Business Conduct, Company Values, and corporate policies.
Ensures the organization and its employees are accountable for compliance and the reporting of non-compliance in accordance with the organization’s Code of Conduct and in support of the annual Compliance Work Plan.
Leads compliance risk assessment activities for the organization’s government programs.
Perform other duties and responsibilities as assigned