This position establishes control points and adherence to all CMS and State Division of Insurance regulations while optimizing Medicare Programs’ professional relationships with CMS Central Office, as well as with each applicable regional office.
- Implement the Medicare Compliance Program.
The Medicare Compliance Officer is accountable for defining the Medicare Compliance Program structure, educational requirements, reporting, and complaint mechanisms, proactive monitoring and mitigation of risk, response and correction procedures, and compliance expectations of all personnel and FDRs supporting Medicare Programs business (including Medicare Advantage, Prescription Drug Program, Medicare-Medicaid Plans and Medicare Supplement).
- Be accountable for managing and coordinating the client’s interactions with CMS. The Medicare Compliance Officer is also responsible for responding to and documenting responses to CMS inquiries
- Be aware of daily business activity by interacting with operational units and applicable FDRs
- Create and coordinate, by appropriate delegation if desired, educational training programs to ensure that applicable governing body, managers, employees, FDRs, and other individuals working/supporting Medicare program are knowledgeable about client’s compliance program, its written Standards of Conduct, compliance policies and procedures, and all applicable statutory and regulatory requirements
- Develop and implement methods and programs that encourage managers, employees, and FDRs to report Medicare program noncompliance and potential FWA without fear of retaliation
- Maintain and/or have access to applicable compliance reporting mechanism and closely coordinating with the Internal Audit Department and the SIU
- Bachelor's degree in a related field (Master's preferred)
- Minimum of 10-15+ years of experience in large, corporate healthcare
- Demonstrated experience managing an enterprise-wide relationship with CMS
- Minimum of 8 years of experience managing a compliance or governance operation in a Medicare environment
- Demonstrated successful leadership skills in program management, program execution, and people management
- Strong analytic skill set to identify and prioritize strategies and initiatives for growth
- Ability to plan, organize, administer, and coordinate a variety of large and complex services, projects, and programs
- Successful leadership and management experience building effective teams, managing cross functional teams, and continuous improvement/staff development programs
- Demonstrated superior oral/written interpersonal communication, persuasion, and negotiation skills
- Strategic thinking and demonstrated organizational leadership capabilities required
- Innovation and creativity, teamwork and communications
- Ability to successfully interface at all levels with the customer, industry, and corporate entities