Medicare Advantage Compliance Program Manager at

This position manages administrative elements of the Companies’ (LHSIC, HMOLA, and VHP) Medicare Advantage Compliance Program, including development and maintenance of program and governance documents such as the Compliance Plan, Risk Assessment, Corrective Action Plans, Committee Charters, Compliance policies and procedures; compliance education and training activities; audit and monitoring work plans; process development improvement; regulatory research, and special projects. Accountable for providing reasonable assurance the compliance program complies with all applicable laws and regulations associated with duties and responsibilities

• This role does not manage people
• This role reports to this job: Director, Medicare Advantage Compliance & Medicare Compliance Officer
• Necessary Contacts: In order to effectively fulfill this position, the incumbent must be in contact with all levels of internal personnel. External contacts include the Department of Insurance, CMS, Blue Cross and Blue Shield Association, providers, subscribers, group leaders, external consultants, attorneys, external auditors, governmental agencies, other Blue Cross plans, and other agencies/businesses as needed.

Education

• Bachelor’s in Accounting, Business Administration, Audit or a related field as deemed necessary by department management required
• Master’s in related field is preferred
• Four years of related experience can be used in lieu of a Bachelor’s degree.

Work Experience

• 7 years Previous experience as a senior compliance consultant or similar role with direct knowledge of CMS Medicare regulations and compliance programs for Medicare Advantage (MA), Medicare Advantage Prescription Drug (MAPD), and/or Prescription Drug Plans (PDP) required

Skills and Abilities

• Position requires strong human relation skills in addition to analytical ability. Also, strong communication skills both written and oral.
• Ability to manage time and personnel on a project and everyday basis.
• Working knowledge of relevant software is required.
• Incumbent must maintain complete confidentiality of information encountered.
• Ability to work extended hours with some travel required.

Licenses and Certifications

• Approved certification such as a, CIA, or CPA must be obtained within 1.5 years of hire required

• Develop, implement, track progress, and report on Compliance objectives, projects, timelines, and deliverables for the Medicare Advantage Compliance Program. Create and maintain compliance dashboards, analyzing and trending data to evaluate performance in compliance program areas. Report information to the CCO, MCO and Compliance Committee and assist in preparing formal reports for the Board of Directors.
• Coordinate compliance program effectiveness tasks to fulfill the goals and objectives of the Medicare Advantage Compliance Program, in collaboration with senior management and stakeholders. Plan, execute, and finalize projects according to identified priorities and deadlines.
• Assist in Compliance oversight of the organization’s contracted entities, in accordance with regulatory requirements, including development, implementation, and management of required systems and processes and the tracking and evaluation of such oversight. Serve as a subject matter expert and research regulatory materials and other guidance; meet with key areas to gain a thorough understanding of a department’s operational procedures; identify relevant compliance information to be incorporated into policies and procedures. Assist stakeholders in analyzing processes and aid in development of policy documents. Analyze, research, develop, write, and/or edit policy and procedure documents according to the Company’s standards, including compliance policies and compliance procedures in accordance with CMS requirements. Effectively communicate current compliance trends and changing requirements related to compliance program effectiveness and educate others on those requirements by conducting research to provide reasonable assurance the compliance program meets CMS expectations.
• Attends assigned meetings, committees and formal and informal training sessions and self-study, to keep abreast of compliance concepts, industry best practices, auditing and investigation skills, as well as interpersonal skills. Job duties are performed in a normal and clean office environment with normal noise levels.
• Work is predominately done while standing or sitting. The ability to comprehend, document, calculate, visualize, and analyze are required.

Additional Accountabilities and Essential Functions
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions

• Perform other job-related duties as assigned, within your scope of responsibilities.
• Job duties are performed in a normal and clean office environment with normal noise levels.
• Work is predominately done while standing or sitting.
• The ability to comprehend, document, calculate, visualize, and analyze are required.

#LI_JH1