Director, Medicaid Compliance - Hybrid

Blue Cross Blue Shield of Arizona•Phoenix, AZ

4d•Hybrid

About The Position

The Director of Medicaid Compliance is responsible for the oversight, administration, and implementation of the Medicaid compliance and accreditation programs. This position reports directly to the General Manager of the Medicaid Segment at BCBSAZ. The Director of Medicaid Compliance shall hold the Corporate Compliance Officer Key Staff Position required by AHCCCS. This position has the authority and responsibility to make independent referrals to the AHCCCS Office of Inspector General or Program Integrity or other duly authorized enforcement agencies relating to reports of fraud and abuse or other non-compliance. This position is responsible for monitoring overall compliance with all deliverables related to the AHCCCS contract and accreditation.

Requirements

8 years or more of corporate compliance, legal or related field of experience is required
8 or more years working in a managed care environment
3 to 5 years of supervisory experience
Bachelor’s in Public Administration, Business Administration, Law, Health Care, Behavioral Health or a related field
Strong analytic skills with the ability to draw conclusions and translate complicated data into useable information that can be clearly communicated.
High tolerance for complex, ambiguous, and shifting environments, including a matrix management structure.
Work within strict deadlines
Ability to communicate clearly with employees at all organizational levels, and across differing cultural backgrounds
Current and applied knowledge of the HIPAA regulation
Excellent Excel skills, accounting software packages and/or spreadsheets
Ability to manage, lead, and motivate people

Nice To Haves

Master’s in Public Administration, Business Administration, Law, Health Care, Behavioral Health or a related field
Experience with project management helpful

Responsibilities

Leads with integrity and confidence, with a strong ability to appropriately identify and communicate risks including but not limited to compliance deliverables, regulatory audits, and accreditation progress.
Solutions oriented mindset with the ability to effectively and collaboratively manage issues to full resolution.
Develops, implements and oversees the Medicaid compliance and accreditation programs; develops an annual compliance and accreditation auditing and monitoring plan in coordination with internal departments; annually evaluates the effectiveness of the plan for internal control assessments.
Develops and monitors compliance policies in accordance with federal and state laws and contract requirements.
Provides oversight and coordination of compliance planning, auditing and risk assessment activities.
Provides prompt response to compliance issues as they are raised, investigation of potential compliance problems as identified during self-evaluation and audits, correction of such problems promptly and thoroughly to reduce the potential for recurrence, ongoing compliance with requirements under the AHCCCS contract, and external monitoring and auditing of subcontractors.
Reviews all necessary information and makes referrals to the state and/or federal Program Integrity offices of non-compliance, as appropriate; tracks and trends all fraud and abuse complaints timely and appropriately based on regulations and internal corporation standards and leads the work of the Medicaid Segment Program Integrity reviewers.
Monitors compliance with contract rules and regulations pertaining to the organization.
Serves as the primary liaison with the AHCCCS compliance officers.
Provides and plans annual compliance training to all staff in the organization related to the detection and reporting of fraud and abuse, Federal False Claims Act, any State laws relating to civil or criminal liability or penalties for false claims and statements, whistleblower protections under such laws, including but not limited to fraud and abuse awareness campaigns.
Coordinates with all departments, senior leadership, and Board of Directors about compliance matters.
Chairs the Compliance Committee and may participate on other committees to ensure compliance within the organization.
Reviews and approves health home compliance programs on an annual basis.
Is located on-site and is available to all staff, with designated and recognized authority to access provider records and make independent referrals to the State Licensing and Contracting agencies including the Office of Inspector General or other duly authorized enforcement agencies.
Leads the charge in focus and implementation of the organization's culture and strategic plan in a way that aligns to the mission, vision, and values of the organization.
Performs other position appropriate duties as required in a competent, professional, and courteous manner.
Perform all other duties as assigned.