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Compliance Officer

Job Summary:

The Medicare Compliance Officer is responsible for ensuring overall compliance with all Medicare compliance activities and programs for the health plan. The position will develop and perform trainings to staff on Medicare topics and new requirements, will manage program requirements such as Health Plan Management System (HPMS) submissions.

Essential Functions:

  • Subject matter expertise in an Medicare Part C and D compliance
  • Ability to review, interpret and implement state and federal guidance
  • Monitors the implementation of the corrective action plans and ensures that the result of the action plans are compliant.
  • Mentor compliance staff and work cross functionally to ensure auditing and monitoring plans are executed
  • Oversee and administer ongoing monitoring program(s) based on guidance
  • Updates policies, procedures and Audit Work Plan based as needed.
  • Adhere to established corporate policies and procedures
  • Perform other duties, as necessary, to meet corporate objectives
  • Travel as required

Qualifications:

  • Bachelor’s degree and a minimum of ten (10) years government, health care, pharmacy benefit management, compliance or quality profession (equivalent combination of education and experience considered.) CHC preferred.
  • Must have strong Microsoft Office Suite skills. Advanced skills in Word, Excel, Access and PowerPoint required
  • Experience with Medicare and/or Medicaid standards required
  • Advanced degree or certification in audit, pharmacy or compliance discipline preferred
  • Must have strong verbal and written communication skills.
  • Individual should be detail oriented with strong organization, prioritization and analytical skills with the ability to work independently.
  • Must work well under tight timelines and adapt quickly to change in a fast-paced, team-oriented, and high-growth environment.

 


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Compliance Officer

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