Lead the compliance function for joint venture contracts and client services for Blue Cross Blue Shield of Michigan’s Medicare Advantage business, including strategic analyses, planning, and implementation. Provide ongoing oversight of federal and state contract requirements within each joint venture and client service contract. Build and maintain business partnerships across the enterprise, subsidiaries, joint venture plans and client services contracts.
RESPONSIBLITIES/TASKS:
- Oversee compliance if joint venture operations by monitoring metrics, corrective actions, Centers for Medicare and Medicaid Services (CMS) regulations, state regulations, etc.
- Create and maintain a Medicare Advantage compliance risk assessment and annual audit plan for all joint venture contracts and client services.
- Coordinate with business owners to implement new joint venture contracts and policy requirements.
- Create and maintain corporate and compliance policies, such as code of business conduct and disclosure processes.
- Execute monitoring and auditing projects including external audit coordination for joint ventures and client services.
- Participate in various oversight and working committees, acting as the compliance subject matter expert to ensure compliance with applicable Medicare Advantage requirements and contractual obligations.
- Advise executive leadership on industry and regulatory requirements and conduct research when necessary to ensure compliance.
- Consult and educate business leaders regarding compliance risk and deviations and offer suggestions, ideas and solutions to ensure corporate compliance.
- Prepare reports and present compliance information to the corporate compliance officer, and audit and compliance committees throughout the year.
- Align business processes across all Medicare Advantage business units to ensure compliance and effective procedures.
- Manage joint venture compliance budget and related intercompany agreements.
DIRECTION EXERCISED:
Directly supervises exempt and non-exempt staff in accordance with company policies and applicable Federal and State Laws. Responsibilities include but are not limited to effectively interviewing, hiring and training employees; planning, assigning and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process.
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.
EMPLOYMENT QUALIFICATIONS:
EDUCATION:
Bachelor’s degree in a related field required. Master’s Degree in related field preferred. Certifications for Compliance and HIPAA such as Certified Healthcare Compliance (CHC) or Certified Compliance & Ethics Professional (CCEP) strongly preferred. Certification or progress toward certification is highly preferred and encouraged.
EXPERIENCE:
Ten years of progressively more responsible experience in an academic, commercial, research or related environment with five years of experience in HIPAA, Medicare Compliance, and regulatory affairs with demonstrated technical experience that provides the necessary knowledge, skills and abilities. risk management and performance improvement preferred. Five years of leadership experience in corporate compliance required.
SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
- Knowledge of CMS standards and practices, regulatory compliance, and HIPAA.
- Ability to resolve conflict and solve complex problems.
- Ability to plan, organize, direct and control projects while applying a wide spectrum of analytical tools, methodologies and project management techniques in order to develop solutions in the absence of guidelines or precedents.
- Proficient in using Microsoft Office Suites to include Excel, Word, and PowerPoint.
- Advanced verbal, written communication and interpersonal skills.
- Ability to develop and present complex materials in a clear, concise, accurate and persuasive manner.
- Ability to work effectively with all levels of the organization and communicate sensitive issues.
- Ability to build strong working relationships with teams and key stakeholders.
- Thorough knowledge of healthcare and healthcare operational compliance, privacy and security and the regulatory requirements impacting a healthcare business associate with significant focus on product data operations.
- Ability to work with Senior Leadership to integrate compliance into daily operations.
- Familiarity with healthcare laws, regulations and standards.
- Strong strategic, analytical, organizational, problem solving, planning, verbal and written communication skills.
- Ability to promote cooperation, communicate sensitive issues, operate with diplomacy and tact, particularly in situations where assessments and opinions may receive strong opposition.
- Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
- Must demonstrate leadership ability and team building skills to effectively supervise professional and non-professional staff and interact with all levels of management.
- Ability to work with and empower others on a collaborative basis to ensure success of unit team.
- Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions and employing active listening techniques.
- Ability to effectively present budgetary and/or cost information, and respond to questions as appropriate.
- Ability to establish workflows, manages multiple projects, and meet necessary deadlines.
WORKING CONDITIONS
Work is performed in an office setting with no unusual hazards. Travel is required.
The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.
We are an Equal Opportunity Employer. Diversity is valued, and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an “at will” basis. Nothing herein is intended to create a contract.
Find one job in US 