About this position
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We are currently seeking an experienced:
COMPLIANCE MANAGER
JOB SUMMARY:
- Serves as the primary compliance contact for CMS and is responsible for ensuring overall compliance with Medicare requirements
- Establish internal controls and processes in support of CMS compliance through project management and engagement of key stakeholders.
- Ensures updates are implemented for all applicable regulatory compliance requirements, including HPMS memos from CMS
- Manage and execute external and internal audits
- Identify and implement changes required to internal policies and processes resulting from audits and regulatory changes
- Develop and implement policies, procedures and practices designed to promote compliance with the requirements set forth in all the requirements of the Federal and State health care programs.
- Identify and assess areas of compliance risks for Liberty Advantage
- Develop and/or ensure internal controls are capable of preventing and detecting significant instances or patterns of illegal, unethical, or improper conduct.
- Monitor compliance with laws, rules, and regulations, as well as Policies and Procedures.
- Develop and/or maintains the comprehensive Medicare Compliance Program for the organization, including responding to all compliance questions or concerns; developing, revising, and presenting Medicare-specific training programs for the organization’s employees, sales staff, and first tier, downstream and related vendors.
- Develops and updates Medicare compliance policies and procedures for the organization to ensure compliance with Federal regulations.
- Responsible for organizational compliance with CMS transmittals, HPMS notices, uploading of Medicare applications, bid submissions, submissions of sales events and Parts C and D reporting data in HPMS, material review and submissions, marketing submissions including code management, and tracks dates and deliverables to ensure that deadlines are met
- Ensures compliance with program requirements and regulations governing service area expansions, Plan Benefit Packages (PBP), and maintaining HPMS information as appropriate.
- Works collaboratively with each department to ensure internal controls are in place and internal monitoring, auditing, and oversight functions are being performed, and that deficiencies are fixed.
- Communicates to and works collaboratively on Medicare compliance activities with the organization's Executive Director
- Prepares monthly compliance summaries for the organization's Executive Director.
JOB REQUIREMENTS:
- Bachelor's degree (required) or Higher, preferred
- HCCA or AHIP certification preferred
- Minimum of 8 years in the health care managed care industry and well versed in CMS policies, rules and regulations of Medicare advantage Part C and D. preferred
- Minimum of 8 years’ experience as a Medicare Compliance Manager preferred
- Health Plan Management System (HPMS) experience
- Special Needs Plan experience preferred
- Proficiency in MS Office, Word, Excel, and PowerPoint
- High degree of interpersonal skills, influence, negotiation and problem-solving abilities and excellent communication skills.
- Strong orientation to deadlines and detail.
- Demonstrated ability to work effectively and congenially with employees at diverse levels.
- Must have a valid drivers’ license.
Visit www.libertycareers.com for more information.
Background checks/drug-free workplace.
EOE.