Medicaid Compliance Officer

Horizon Blue Cross Blue Shield of New Jersey•Newark, NJ

About The Position

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. About the Role Accountable for the oversight, implementation, and execution of the Medicaid regulatory compliance program. Leads the design, execution, and continuous improvement of a comprehensive compliance program, with responsibility for regulatory interpretation, implementation, audit readiness, risk identification, controls oversight, and issue remediation. Partners cross-functionally with internal stakeholders and senior leadership to promote compliance, strengthen governance, and ensure timely escalation and reporting of key risks. Provides leadership for teams and serves as a primary point of contact for external regulators. In the Medicaid Compliance Officer context, this role also oversees state-driven Medicaid regulatory requirements, manages relationships with Medicaid-specific agencies, and leads Medicaid audit and compliance review activities.

Requirements

Minimum of 10 years of regulatory compliance experience in healthcare or legal.
Minimum of 5 years of managerial experience.
Requires experience working with regulatory agencies.
Bachelor's degree preferred or relevant experience in lieu of a degree.
Prefers JD.

Nice To Haves

Certified Compliance & Ethics Professional (CCEP)
Certified in Healthcare Compliance (CHC)
Leadership Professional in Ethics & Compliance (LPEC)

Responsibilities

Owns Medicaid compliance program design, monitoring, audit readiness, issue management, and remediation.
Leads compliance with risk assessments and audit planning.
Oversees intake, investigation, and resolution of potential non-compliance.
Partners with Legal, Government Affairs, and business leaders on regulatory interpretation.
Reports material compliance risks to senior leadership and the Chief Compliance Officer.
Leads and develops compliance staff.
Primary regulatory contact for Medicaid matters with regulatory agencies specifically DOBI, DMAHS, and Medicaid Fraud Division (MFD) and Office of Inspector General (OIG) and other related agencies.
Coordinates state and federal regulatory and legislative activity impacting Medicaid.
Oversees responses to regulatory and legislative complaints.
Supports internal teams on Medicaid regulatory requirements.