Compliance Manager, Healthcare

Compliance Manager

We are currently seeking an experienced Compliance Manager to serve as the primary compliance contact for CMS and ensure overall compliance with Medicare requirements.

• 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

• 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 Power Point
• 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 driver’s license

Location:

Wilmington, NC

Salary: $53,668.00 – $91,234.00

EOE.