Medicaid Compliance Officer

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

23h

About The Position

Horizon Blue Cross Blue Shield of New Jersey empowers its members to achieve their best health. For over 90 years, the company has been New Jersey’s health solutions leader, driving innovations that improve health care quality, affordability, and member experience. The company's members are neighbors, friends, and families, which drives them to better serve and care for the 3.5 million people who place their trust in them. Horizon prides itself on its best-in-class employees and strives to maintain an innovative and inclusive environment that allows them to thrive. The Medicaid Compliance Officer is accountable for the oversight, implementation, and execution of the Medicaid regulatory compliance program.

Requirements

HSD or GED required
Relevant experience in lieu of a Bachelor's degree

Nice To Haves

Bachelor's degree preferred

Responsibilities

Owns Medicaid compliance program design, monitoring, audit readiness, issue management, and remediation.
Leads compliance 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 regulator and legislative complaints.
Supports internal teams on Medicaid regulatory requirements