Medicare Compliance Officer

CommonSpirit Health • Phoenix, AZ

6d

About The Position

Develops, operates and administers the regulatory compliance program for both Medicare Advantage (Part C) and Medicare Part-D plan activities for Mercy Care Plan. Mercy Care Plan is managed by Schaller Anderson, an Aetna Company. Reports directly to the Plan CEO and the Audit and Compliance Committee of the Board of Directors of SCHN. Develops and monitors the implementation of and compliance with Medicare policies and procedures through the creation and implementation of a work plan. Reports, at least on a quarterly basis, or more frequently as necessary, to the board of directors, president and/or CEO, and compliance committee, on the status of Mercy Care Plan's Medicare compliance program implementation, the identification and resolution of potential or actual instances of noncompliance, and the Plan's oversight and audit activities. Creates and coordinates, or appropriately delegates, educational training programs to ensure that the Plan's officers, directors, managers, employees, and other individuals working on the Medicare program are knowledgeable of Mercy Care Plan's compliance program; its written standards of conduct, policies, and procedures; and the applicable statutory, regulatory, and other requirements. Ensures that first tier entities, downstream entities, and related entities, particularly those involved in sales and marketing activities, are aware of and follow the requirements for Medicare sales and marketing activities. Briefs the compliance committee and governing body on the status of compliance training.

Requirements

• Bachelors Other or an equivalent combination of directly related workexperience and/or education
• Five (5) years of experience thatdemonstrates solid Medicare complianceprogram development, operation andadministration responsibilities, upon hire

Nice To Haves

• Registered Nurse: AZ, upon hire

Responsibilities

• Develops, operates and administers the regulatory compliance program for both Medicare Advantage (Part C) and Medicare Part-D plan activities for Mercy Care Plan.
• Develops and monitors the implementation of and compliance with Medicare policies and procedures through the creation and implementation of a work plan.
• Reports, at least on a quarterly basis, or more frequently as necessary, to the board of directors, president and/or CEO, and compliance committee, on the status of Mercy Care Plan's Medicare compliance program implementation, the identification and resolution of potential or actual instances of noncompliance, and the Plan's oversight and audit activities.
• Creates and coordinates, or appropriately delegates, educational training programs to ensure that the Plan's officers, directors, managers, employees, and other individuals working on the Medicare program are knowledgeable of Mercy Care Plan's compliance program; its written standards of conduct, policies, and procedures; and the applicable statutory, regulatory, and other requirements.
• Ensures that first tier entities, downstream entities, and related entities, particularly those involved in sales and marketing activities, are aware of and follow the requirements for Medicare sales and marketing activities.
• Briefs the compliance committee and governing body on the status of compliance training.

What This Job Offers

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