Program Manager, Medicare Compliance
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Job Description
Program Manager in Medicare Compliance overseeing compliance activities for Arkansas Blue Cross. Responsible for managing operations, regulatory affairs, and training employees on compliance regulations.
Responsibilities:
- Assisting with all Medicare Advantage (MA) compliance activities.
- Managing operations of Compliance, including components of administration, interpretation, and enforcement of the Compliance Program.
- Managing regulatory affairs, prevention, detection, and correction functions of Compliance.
- Continually analyzing business needs, identify potential problems, ensure effective lines of communicating business and compliance issues, and assist in remediation.
- Develops and maintains strong working relationships, collaborating and consulting with business and regulatory partners.
- Develops and oversees a system for uniform response, enforcement and corrective action on matters relating to MA compliance.
- Ensures that employees are trained on ABCBS’ commitment to compliance with all applicable federal and state laws and regulations.
Requirements:
- Bachelor's degree required.
- Certification in Health Care Compliance or pursuit of certification preferred.
- Minimum seven (7) years' government compliance experience in a healthcare insurance or CMS government program environment.
- OR applicable Masters in related field and Certified Healthcare Compliance designation with minimum five (5) years' experience.
- Minimum three (3) years' direct Medicare Advantage compliance experience.
- Minimum two (2) years' leadership experience (role, team lead, project management, etc.).
- Strong understanding of CMS requirements and regulations related to Medicare Advantage and Medicare Part D operations and compliance.
- Experience with CMS Program Audits.
- Strong knowledge of CMS regulations pertaining to compliance in a managed care health plan, and the Medicare Managed Care Manual, is a must.
Benefits:
- Tuition reimbursement.
- Club Blue, a free, onsite gym to encourage exercise.
- Green Leaf Grill and Green Leaf Grill Express, onsite restaurants in Little Rock that promote healthy eating.
- Incentives for wellness education and exercise
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