Job Description
To learn more about Arkansas Blue Cross and Blue Shield Hiring Policies, please click here . Job Summary The Program Manager Medicare Compliance is responsible for assisting with all Medicare Advantage (MA) compliance activities. The position manages the operations of Compliance, including components of the administration, interpretation, and enforcement of the Compliance Program and managing the regulatory affairs, prevention, detection, and correction functions of Compliance. Requirements EDUCATION Bachelor's degree required. LICENSING/CERTIFICATION Certification in Health Care Compliance or pursuit of certification preferred. EXPERIENCE Minimum seven (7) years' government compliance experience in a healthcare insurance or CMS government program environment. OR applicable Masters in related field and Certified Healthcare Compliance designation with minimum five (5) years' experience. Minimum three (3) years' direct Medicare Advantage compliance experience. Minimum two (2) years' leadership experience (role, team lead, project management, etc.) Strong understanding of CMS requirements and regulations related to Medicare Advantage and Medicare Part D operations and compliance. Experience with CMS Program Audits. Financial audits, data validation audits, CMS reviews, and CMS’ HPMS modules required. Strong knowledge of CMS regulations pertaining to compliance in a managed care health plan, and the Medicare Managed Care Manual, is a must. Compliance experience coupled with excellent “hands-on” development, implementation, and maintenance of compliance programs, policies and procedures. Strong understanding of the seven elements of an effective compliance program and the CMS methodology of Prevent, Detect, and Correct Knowledge of applicable legislation/regulations and responsible for departmental implementation and ongoing compliance. ESSENTIAL SKILLS & ABILITIES Oral & Written Communication Collaborative Project Management Organizational Ability to work with cross-fun
