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Medicare Compliance Sr. Manager

Major Responsibilities: Develop, maintain, and update an annual compliance risk assessment and monitoring and auditing workplan; Develop appropriate compliance reports, including dashboards, tracking logs, and summary reports that communicate the status of the compliance program to the Compliance Officer and Senior Company Leaders. Develop and administer internal auditing & monitoring procedures that assess operational performance against CMS standards. Distribute clear audit reports that describe audit risks and failures. Work with appropriate business leaders to identify and track corrective action plans to successful completion. Act as point of contact with Centers for Medicare and Medicaid Services (CMS) regional/central offices Ensure operational preparation for CMS program and compliance audits Lead monitoring activities across multiple operational areas to identify areas of potential compliance risk and develop solutions for risk mitigation Implement Vendor Oversight Program, including focus on PBM operations. Oversee a staff that analyzes and communicate new Medicare policy and regulations to all business areas and track implementation. Oversee a staff that develops annual Compliance training content and ensure timely distribution Provide written and oral advice and guidance regarding compliance requirements that impact the company's products and business Performs management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plans, organizes, staffs, directs and controls the day-to-day operations of the department; develops and implements policies and programs as necessary. Challenges/Problem Solving:  Conducting audits and interpreting results to determine any required corrective action.  Working with business area leaders to negotiate implementation of audits and corrective action. Working with vendors to negotiate implementation of audits and corrective action. Interpreting CMS guidelines to apply to ongoing committee structure and agenda Development of agenda topics, including presentation of controversial subjects to several leaders across many business areas.                           Decision Making Authority:  High degree of decision making authority is required for this position. High degree of Leadership is required for working with vendors, CMS, internal business leaders, external association representatives, consultants and other Health Plan Compliance Professionals. Strong ability to resolve different opinions among leaders in a professional manner. Leadership Responsibilities:     Project management responsibilities within the Compliance team Managing a team of three to complete all required responsibilities Managing projects in a matrixed environment  Allocation of limited budget dollars for annual auditing purposes Completion of deliverables in accordance with established timelines Work with outside entities, including vendors, CMS, external association representatives, consultants and other Health Plan Compliance Professionals to achieve BCBSMA goals and compliance with CMS requirements. Qualifications: Knowledge of CMS, Medicare Advantage and Part D regulations/compliance Superior project management skills Keen verbal and written communication skills Critical thinking and analytic skills Ability to apply government regulations and translate those to business requirements Ability to manager timelines and multiple priorities and projects High degree of professionalism Education/Relevant Experience: Bachelor's degree. Subject are Business, Healthcare, Public Policy, Accounting or other related area preferred 7 years of Health Plan experience 5 years of experience working with Medicare products. 4 years of  experience working in health care compliance, audit, or operations 2 years management experience Experience with overseeing implementation of contract requirements. Previous experience demonstrating effective communication with federal and state regulatory agencies preferred. Knowledge of Medicare and CMS regulations and software application tools preferred. Experience interacting with federal government agencies is a plus. R01776
Salary Range: NA
Minimum Qualification
5 - 7 years

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