Program Manager, Medicare Compliance

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Arkansas Blue Cross and Blue Shield

WebsiteLinkedInAlle Stellen

1001 - 5000 Mitarbeiter

Gegründet 1948

⚕️ Krankenversicherung

Healthcare Insurance

Arkansas Blue Cross und Blue Shield ist ein Krankenversicherer, der lizenziert ist, um Gesundheitspläne in allen 75 Bezirken von Arkansas anzubieten. Das Unternehmen bietet eine breite Palette von Versicherungsprodukten an, darunter Einzel- und Familienpläne, Medicare- und Medigap-Pläne, Zahn- und Sehpläne sowie Gesundheitspläne für Reisende und Gruppenpläne für Arbeitgeber. Sie bieten Mitgliedern personalisierte Dienstleistungen wie das Gesundheitsmanagement über das Blueprint-Portal, auf dem Nutzer ihren Gesundheitsplan verwalten, Ansprüche überprüfen, Gesundheitsdienstleister finden und Behandlungskosten schätzen können. Arkansas Blue Cross und Blue Shield ist ein unabhängiger Lizenznehmer der Blue Cross und Blue Shield Association.

Beschreibung

• 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 matters 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 all 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 raise 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 all MA compliance issues received by the compliance hotline or through any other mechanism, maintain a record of all allegations which may constitute a material violation of applicable laws or regulations, and conduct a preliminary review and, if necessary, an investigation of any credible allegation of non-compliance. • Manages the development and participation in regular, multifaceted communication, educational, and training programs to ensure all Company directors, officers, employees, consultants, vendors and subcontractors who work on MA products are knowledgeable about and comply with the MA Compliance Program, and all federal, state and local laws and regulations. • Oversees vendor compliance. • Works with internal and external auditors, as necessary, to ensure effective coordination and implementation of audit requests, and ensure audit readiness.

🎯 Anforderungen

• 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. • 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.

🏖️ Vorteile

• 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.