Director, Medicare Compliance - Hybrid

Blue Cross Blue Shield of Arizona•Phoenix, AZ

12d•Hybrid

About The Position

Responsible for ensuring overall compliance with all Corporate and Medicare compliance activities and programs. Serves as the Medicare Compliance Officer and is the primary point of contact for the Centers for Medicare and Medicaid Services (CMS) for Medicare products. The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements. This position currently requires 2 days in office and 3 remote workdays.

Requirements

5+ years of management experience
7+ years of experience in corporate compliance
5+ years of experience in Medicare Advantage program compliance
Bachelor’s Degree in business, healthcare policy, judicial studies, ethics or related field
Intermediate PC proficiency.
Intermediate proficiency in spreadsheet, database and word processing.
Organizational skills and strong logical thinking ability
Maintain confidentiality and privacy.
Communicate professionally to both internal and external customers.
Analyze and research data, propose solutions to resolve issues.
Establish, contribute and maintain a positive and productive work environment.
Ability to plan, organize and manage the work of all assigned personnel.
Ability to collaborate and think globally.
Must possess strong interpersonal skills, as well as effective oral and written communication skills.
Ability to optimize resources to ensure a cost effective operation. Includes proactively planning to move staff from one role to another as staffing needs, business priorities or workload changes.
Ability to build efffective teams.
Ability to implement new processes and procedures.
Ability to persuade and instill effective cooperation and compliance. Develop rapport and facilitate cooperation, as well as apply corrective actions.

Nice To Haves

Experience serving as Medicare Compliance Officer
Experience leading CMS program audit readiness and response
Experience with FDR oversight and delegated entity compliance
Experience presenting to executive leadership, compliance committees, and governing boards
Experience managing compliance issue investigations, corrective action plans, and regulatory reporting
Master’s Degree in business, healthcare policy, judicial studies, ethics or related field
CHC, CHPC, or similar certification
Ability to establish and maintain professional relationships with community and professional groups which reflect favorably for the department and BCBSAZ.
Ability to coordinate activities of several departments to resolve issues.

Responsibilities

Develops and/or maintains the comprehensive Medicare Compliance Programs and Work Plans 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)
Reports to the MediSun Board and other appropriate committees on the activities of the Medicare Compliance Program
Acts as compliance liaison for Medicare products with the Centers for Medicare and Medicaid Services (CMS), maintaining a positive relationship with the CMS Account Manager/Regional Office
Prepares for and responds to CMS and other external audits.
Chairs various Medicare Compliance committees for appropriate oversight
Manages Medicare Program requirements, such as Health Plan Management System (HPMS) submissions.
Evaluates and communicates the impact of regulatory changes and CMS guidance on Medicare compliance program requirements.
Oversees internal, initial and final compliance review reports. Maintain records of compliance investigation activity and track to ensure all work papers within each investigation or review are accurately controlled.
Oversees identification, assessment, monitoring, and reporting of Medicare compliance risks and emerging regulatory requirements.
Oversees development, implementation, and monitoring of corrective action plans arising from compliance reviews, audits, investigations, and regulatory findings.
Monitors quality performance measures, develops and maintains effective workflows, and seeks to maximize system efficiencies.
Oversees day-to-day departmental administration and personnel by coaching and motivating departmental personnel to make maximum use of experience and skills.
Participates in strategic planning activities and contribute to departmental and cross-functional teams to achieve BCBSAZ goals and ensure future success.
Conducts performance evaluations, identifies and coordinates training needs, and makes determinations regarding disciplinary actions.
Maintains effective working relationships to ensure teamwork in achieving corporate goals.
Consults and coordinates with various internal departments, external Blue Plans or business partners and government agencies where appropriate.
Supports enterprise compliance initiatives and provides leadership for assigned corporate compliance activities, monitoring, investigations, training, and reporting.
Perform all other duties as assigned.