Manager, Medicare Compliance

Medical Mutual of Ohio

110d

About The Position

The Manager, Medicare Compliance is responsible for leading the implementation and day-to-day management of Medical Mutual's Medicare Compliance Program, which supports both Medicare Advantage and Medicare Supplement products. This position reports directly to the Chief Compliance Officer and ensures adherence to regulatory requirements through the development of policies, delivery of training, participation in annual compliance risk assessment and work plan development, and oversight of auditing and reporting activities.

Requirements

• Bachelor's degree required; Master's degree preferred.
• 8 years of experience in health care compliance required.
• At least 5 years of experience in Medicare Advantage preferred.
• Strong knowledge of Statutory and Federal laws and Regulations that affect various company products, including Medicare Advantage.
• Strong understanding of operational, financial, and regulatory controls and risks.
• Proficiency with PC and MS Office suite; familiarity with LAN / WAN applications.

Responsibilities

• Manages the implementation and operation of the Medical Mutual Medicare Compliance Program.
• Serves as Medical Mutual's Medicare Compliance Officer.
• Participates in annual compliance risk assessment and work plan development.
• Develops and delivers Medicare compliance education, training, and awareness materials.
• Ensures Medicare policies and procedures are properly created, implemented, and monitored.
• Conducts and/or oversees Medicare compliance reviews and investigations.
• Facilitates Medicare Compliance Work Group meetings.
• Triages Medicare compliance issues and questions received from business areas and ensures provision of accurate and timely responses and recommendations.
• Escalates compliance issues or concerns as necessary.
• Oversees Medicare Compliance projects and initiatives.
• Designs and executes risk management strategies.
• Prepares and submits compliance reports to regulatory agencies including the Centers for Medicare and Medicaid Services.
• Plans, coordinates, and/or oversees auditing, monitoring, and due diligence activities.
• Develops corrective actions and tracks their progress to resolution.
• Performs other duties as assigned.

Benefits

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance.
• Access to an Employee Assistance Program.
• Company holidays and up to 16 PTO days during the first year of employment.
• Parental leave for eligible employees after 120 days of service.
• Career development programs and classes.
• Tuition reimbursement up to $5,250 per year.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree