Manager Medicare Compliance

CommonSpirit Health • Phoenix, AZ

3d

About The Position

The Medicare Compliance Officer (MCO) is responsible for developing, implementing, and overseeing the compliance program for Medicare Advantage (Part C) and Medicare Part D activities for Mercy Care Plan, managed by Aetna, a CVS Company. This role ensures adherence to all applicable federal and state regulations and CMS requirements, safeguarding the integrity and compliance of Plan operations.
Reporting Structure: This position will maintain day-to-day operational alignment with the Mercy Care Medicare team while holding direct reporting accountability to the Chief Executive Officer (CEO) and the Audit and Compliance Committee of the Mercy Care Plan Board of Directors. Provide formal reports to the Board of Directors, CEO, and Compliance Committee at least quarterly, and more frequently as needed, detailing the status of Mercy Care Plan’s Medicare Compliance Program implementation, identification and resolution of compliance issues, and oversight and audit activities. Oversee the development and administration of the Board of Directors’ annual Code of Conduct and compliance training program, including program design, content creation, distribution, tracking, and ongoing maintenance to ensure full compliance with regulatory and organizational standards. Develop and implement programs and mechanisms that promote a culture of integrity by encouraging managers and employees to report suspected fraud, waste, abuse, or other misconduct, ensuring confidentiality and protection against retaliation. Respond promptly to reports of potential Medicare fraud, waste, or abuse, (FWA) including coordinating internal investigations and developing appropriate corrective or disciplinary actions when necessary. Maintain the FWA reporting mechanism and collaborate closely with the Internal Audit Department and the Special Investigations Unit (SIU), as applicable. Exercise flexibility in designing and managing internal investigations (e.g., addressing suspected violations or reported issues) and implementing resulting corrective measures, such as policy enhancements and disciplinary actions to ensure compliance and mitigate risk. Coordinate with the Plan’s Human Resources department (or equivalent) to ensure thorough screening of the DHHS OIG and GSA exclusion lists for all employees, officers, directors, managers, and contracted entities, including first-tier, downstream, and related entities, confirming none are listed on these exclusions.

Requirements

• Bachelors Other or an equivalent combination of directly related workexperience and/or education
• Five (5) years of experience that demonstrates solid Medicare compliance program development, operation and administration responsibilities

Nice To Haves

• Registered Nurse: AZ
• Strong Business acumen and healthcare industry

Responsibilities

• Developing, implementing, and overseeing the compliance program for Medicare Advantage (Part C) and Medicare Part D activities
• Ensuring adherence to all applicable federal and state regulations and CMS requirements
• Providing formal reports to the Board of Directors, CEO, and Compliance Committee
• Overseeing the development and administration of the Board of Directors’ annual Code of Conduct and compliance training program
• Developing and implementing programs and mechanisms that promote a culture of integrity
• Responding promptly to reports of potential Medicare fraud, waste, or abuse, (FWA)
• Maintaining the FWA reporting mechanism and collaborate closely with the Internal Audit Department and the Special Investigations Unit (SIU)
• Exercising flexibility in designing and managing internal investigations
• Coordinating with the Plan’s Human Resources department (or equivalent) to ensure thorough screening of the DHHS OIG and GSA exclusion lists

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees