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Program Manager, Medicare Compliance
Arkansas Blue Cross and Blue ShieldProgram Manager in Medicare Compliance overseeing compliance activities for Arkansas Blue Cross. Responsible for managing operations, regulatory affairs, and training employees on compliance regulations.
About the role
Key responsibilities & impact- Assisting with all Medicare Advantage (MA) compliance activities.
- Managing operations of Compliance, including components of administration, interpretation, and enforcement of the Compliance Program.
- Managing regulatory affairs, prevention, detection, and correction functions of Compliance.
- Continually analyzing business needs, identify potential problems, ensure effective lines of communicating business and compliance issues, and assist in remediation.
- Develops and maintains strong working relationships, collaborating and consulting with business and regulatory partners.
- Develops and oversees a system for uniform response, enforcement and corrective action on matters relating to MA compliance.
- Ensures that employees are trained on ABCBS’ commitment to compliance with all applicable federal and state laws and regulations.
Requirements
What you’ll need- Bachelor's degree required.
- Certification in Health Care Compliance or pursuit of certification preferred.
- 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.
- Strong knowledge of CMS regulations pertaining to compliance in a managed care health plan, and the Medicare Managed Care Manual, is a must.
Benefits
Comp & perks- Tuition reimbursement.
- Club Blue, a free, onsite gym to encourage exercise.
- Green Leaf Grill and Green Leaf Grill Express, onsite restaurants in Little Rock that promote healthy eating.
- Incentives for wellness education and exercise
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Medicare Advantage compliancegovernment complianceregulatory affairscompliance program administrationCMS Program Auditscompliance enforcementcorrective actionbusiness analysisproblem identificationtraining development
Soft Skills
collaborationconsultationcommunicationleadershipproject managementrelationship buildingproblem-solvingorganizational skillsanalytical skillsremediation assistance
Certifications
Bachelor's degreeHealth Care Compliance certificationCertified Healthcare Compliance designation