100% remote opportunity in the US; core CST hours
The Government Contracts Compliance Officer ("Chief Compliance Officer") is responsible for implementing, administering, and managing the Medicare Compliance Program for all clients'
Medicare Advantage Health PlansIn collaboration with the CEO/President, and Chief Operations Officer, the Chief Compliance Officer will develop and oversee all aspects of the Medicare compliance program, including policy management, compliance training and education, effective communication channels, auditing and monitoring, investigations and corrective actions, and reporting.
Essential Functions- Serves as a subject matter expert on Government Contract compliance matters (Medicare); delivering relevant regulatory compliance guidance in a concise, meaningful, and actionable manner and partnering with business areas, IT, and/or FDRs to execute on Medicare compliance requirements.
- Develops, initiates, maintains, and revises policies and procedures for the general operation of the Compliance Program and its related activities to prevent illegal, unethical or improper conduct.
- Designs, develops, implements, and evaluates compliance training for all levels of staff to support an awareness and understanding of Medicare (and Medicaid as required) requirements.
- In collaboration with the CEO/President and Chief Operations Officer, conducts the annual risk assessment process, as well as periodic re-evaluations.
- Designs, develops, implements, and evaluates audit, monitoring, and assessment tools and evaluation processes. Conducts audits in accordance with the Compliance work plan.
- Institutes and ensures an effective compliance communication program for the organization, including promoting the use of the Compliance Hotline and awareness of the organization's Code of Conduct.
- Conducts investigations of non-compliance (including root cause and impact analyses), establishes a retribution-free system for reporting of noncompliance or compliance concerns, and develops and implements corrective action plans. Works in conjunction with Human Resources to enforce disciplinary actions.
- In conjunction with the CEO/President and Chief Operations Officer, oversees external regulatory and enforcement actions (i.e., data requests, audits, etc.)
- Prepares reports and presentations required by the Compliance Committee, Executive Leadership, and the Board of Directors regarding Medicare compliance activities.
- May serve as the primary CMS compliance contact.
- Performs other related duties as assigned.
Education- Bachelor's Degree Required.
- Healthcare related graduate degree (e.g., JD, MA, MPH, MHA, MD, RN, PhD) or equivalent education preferred
Knowledge and Experience- 7 + years of Medicare Advantage and Prescription Drug Plan experience required.
- 7 + years of regulatory/compliance/legal experience required.
- 5 + years of leadership experience required.
- Certification in Health Care Compliance ("CHC") required or must be obtained within 12 months of hire.
- Experience managing a compliance department with demonstrated ability to establish and maintain a compliance program.
- Proficient in the use of computers and Microsoft PowerPoint, SharePoint, Word, and Excel
- Excellent research skills, attention to detail, and oral and written communication skills.
- Ability to manage complexity and multiple projects simultaneously.
- Familiarity with Federal healthcare program requirements and Federal fraud and abuse laws
- Knowledge and familiarity with CMS, Medicare Advantage and Part D programs
- Familiarity with State Medicaid programs
- Detailed, working knowledge of compliance program structure, requirements and procedures.
Candidates must meet the Company's hiring criteria which includes a pre-employment background and drug screening.
