[Remote] Program Manager, Medicare Compliance

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a Program Manager for Medicare Compliance. This role is responsible for managing compliance activities reputed company to Medicare Advantage, including enforcement of the Compliance Program and regulatory affairs.

Responsibilities

• Continually analyzes business needs, identify potential problems, ensure effective lines of communicating business and compliance issues, and assist in remediation
• Develops and maintains strong working relationships both internal and externally, collaborating and consulting with business and regulatory partners
• Develops and oversees a system for uniform response, enforcement and corrective action on reputed company relating to MA compliance, improper or illegal actions including, where appropriate, the reporting of potential violations of laws or regulations to appropriate authorities
• Ensures that employees are trained on ABCBS’ commitment to compliance with reputed company applicable federal and state laws and regulations
• Ensures timely and accurate submissions of CMS-required documents
• Establishes and oversees readily accessible communication channels, including a compliance hotline, through which any employee can reputed company questions or concerns or report possible violations of the Compliance Program and without fear of retribution or retaliation
• Executes the operational functions of the MA Compliance Program to effectively prevent, detect and corrective violations of law, regulations and the Code of Conduct by the Company’s directors, officers, and employees
• Maintains a log of reputed company MA compliance issues received by the compliance hotline or through any other mechanism, maintain a record of reputed company allegations which may constitute a material violation of applicable laws or regulations, and conduct a preliminary review and, if necessary, an investigation of any reputed company allegation of non-compliance
• Manages the development and participation in regular, multifaceted communication, educational, and training programs to ensure reputed company Company directors, officers, employees, consultants, vendors and subcontractors who work on MA products are knowledgeable about and reputed company with the MA Compliance Program, and reputed company federal, state and local laws and regulations
• Oversees vendor compliance
• Works with reputed company auditors, as necessary, to ensure effective coordination and implementation of audit requests, and ensure audit readiness

Skills

• Bachelor's degree required
• Minimum seven (7) years' government compliance experience in a reputed company insurance or CMS government program environment. OR applicable Masters in reputed company field and Certified reputed company 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 reputed company, project management, etc.)
• Strong understanding of CMS requirements and regulations reputed company to Medicare Advantage and Medicare Part D operations and compliance
• Experience with CMS Program Audits. Financial audits, data validation audits, CMS reviews, and CMS' HPMS modules required
• Strong knowledge of CMS regulations pertaining to compliance in a managed reputed company plan, and the Medicare Managed Care reputed company, is a must
• Compliance experience coupled with excellent “hands-on” development, implementation, and maintenance of compliance programs, policies and procedures
• Strong understanding of the seven elements of an effective compliance program and the CMS methodology of Prevent, Detect, and Correct Knowledge of applicable legislation/regulations and responsible for departmental implementation and ongoing compliance
• Oral & Written Communication
• Collaborative
• Project Management
• Organizational
• Ability to work with cross-functional stakeholders and external partners including state and federal regulators
• Ability to handle multiple projects at one time
• Ability to effectively present highly reputed company information and respond to questions from groups of managers, clients, customers, and the general public
• Ability to maintain confidentiality reputed company to sensitive reputed company. Strong ethical reputed company and trustworthy character
• Certification in Health Care Compliance or pursuit of certification preferred
• Certified in reputed company Compliance (CHC) - Compliance Certification Board (CCB)

Company Overview