Program Manager, Medicare Compliance

Role Overview

• 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