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Medicare Compliance Manager

The Medicare Compliance Manager works to implement and improve the Medicare Compliance Program to achieve compliance with CMS Medicare Compliance Program requirements. Serves as a subject matter expert for Parts C and D. Partners with operational areas to provide guidance and compliance expertise on new or updated CMS requirements. Oversees monitoring and audits (both internal and external) activities for the Medicare product.

Representative Duties:
• The Medicare Compliance Manager works to implement and improve the Medicare Compliance Program to achieve compliance with CMS Medicare Compliance Program requirements.
• Monitor and track the development and publication of Medicare Policies, Standards and Procedures throughout the organization.
• Implements, tracks and reports on Medicare monitoring, audit and compliance review activities.
• Works with the Medicare Compliance Officer to implement and track corrective action program.
• Consult with other departments as a SME on the requirements of Medicare Advantage; assist in orienting the organization to Medicare laws and regulations and compliance standards.
• Prepare dashboards and other reports for the Compliance Committee and Board of Directors.
• Prepares reports for the Compliance Committee.
• Align department plans, strategies and annual budget with the company’s organizational plans and strategies.
• Maintain consistently high performance standards for all direct reports and other team members by regularly communicating business updates, coaching, counseling, disciplining and completing timely performance evaluations in accordance with the company’s Human Resources guidelines and standards.
• Establish and execute professional development initiatives for direct reports and other team members and their self for the purpose of keeping current and effective in the performance of their various job duties and roles.
• Implements an oversight program for Medicare FDRs to determine compliance with CMS laws and regulations.
• Monitors that all necessary Medicare required files and submissions are performed timely.
• Assists with implementation of the Medicare Anti-Fraud program.
• Oversee the implementation of operational changes arising from new laws, regulations, regulatory guidance and subguidance, HPMS memos that affected departments, FDR’s and vendors.
• Collaborates with other departments to address compliance issues, identify opportunities for improvement; ensure the organization has and maintains appropriate information and other materials needed to assure compliance by all departments.
• Update job knowledge by participating in educational opportunities and reading professional publications.
• Represent and effectively present compliance metrics, project updates and other miscellaneous information to a variety of internal and/or external organizations.
• Works with the Medicare Compliance Office to develop and maintain good relationships with representatives of Medicare / CMS Regional and Central Offices relevant to the success of the Compliance Program, Compliance Department and WHA.

• Bachelor’s Degree in a related field.
• 5 years’ experience in a Medicare Compliance related role within a health care organization or regulator with increasing leadership responsibilities.
• Certification in compliance from a recognized national organization, such as HCCA, strongly preferred.

Time:  Full time
Salary:  Salary
Category:  Compliance

Updated: 12/10/2020 4:26:23 PM

Job Contact:
Becky Nelson
(916) 437-3239

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2349 Gateway Oaks Dr
Sacramento, CA 95833

(916) 437-3239