Medicare Compliance Officer

Overview

You are the primary contact for Centers for Medicare and Medicaid Services (CMS) for Medicare compliance communications for one or more Rubicon portfolio companies. You are responsible for ensuring overall compliance with all Medicare compliance activities and programs as we stand up our program and as we scale operations. As the face of compliance, you’re focused on building a brand for your function that creatively reaches our teams through trainings on Medicare topics and their requirements. You are committed to creating a culture where compliance is viewed as a team effort, and everyone plays their part. You reach our teams through thoughtful training programs. You manager our program requirements such as Health Plan Management System (HPMS) submissions. This role is based in Nashville, TN. Relocation is required, a relocation package is available. Required Skills Basic Qualifications: •A Bachelor’s degree in Health Care Administration or other related field required, Master’s degree in Health Care Administration, Business Administration, Public Administration, Clinical Area, etc. •Five (5) years’ experience with Medicare Managed Care programs is required. Knowledge of CMS and Medicare Advantage Prescription Drug Plans and Special Needs Plans and Health Care Compliance Certification is preferred. •Five (5) years’ functioning as a Medicare Compliance Officer. Experience standing up a compliance department preferred, as well as time in position leading the compliance team. •Must be able to evaluate and analyze regulations, interpret significance, and recommend policies to comply and apply and ensure compliance to applicable regulations. •Excellent communication skills, you must be comfortable leading group meetings, including training events for employees. Essential Responsibilities: •Serves as the primary Centers for Medicare and Medicaid Services (CMS) compliance contact and the person responsible for ensuring overall compliance with Medicare compliance requirements. •Oversee and monitor all aspects of the implementation of the Medicare compliance program, including an annual schedule of compliance activities. •Coordinates and communicates to internal departments and external vendors, where appropriate all Medicare compliance activities and programs as well as plans, implements and monitors the organization’s Medicare compliance program. •Develops and/or maintains the comprehensive Medicare Compliance Program for the organization, including responding to all compliance questions or concerns, developing, revising and presenting Medicare-specific training programs for the organization’s employees, sales staff, and first tier, downstream and related vendors. •Develops and updates Medicare compliance policies and procedures for the organization to ensure compliance with Federal regulations. •Responsible for organizational compliance with CMS transmittals, HPMS notices, uploading of Medicare applications, bid submissions, submissions of sales events and Parts C and D reporting data in HPMS, material review and submissions, marketing submissions including code management, and tracks dates and deliverables to ensure that deadlines are, as well as all CMS audits and producing corrective action plans as necessary. •Ensures compliance with program requirements and regulations governing service area expansions, Plan Benefit Packages (PBP), and maintaining HPMS information as appropriate. •Works collaboratively with internal auditors to ensure that internal controls are in place and internal monitoring, auditing and oversight functions are being performed, and that deficiencies are fixed. •Communicates to and works collaboratively on Medicare compliance activities with the organization’s executive team. •Manages and coordinates Medicare external audits, including CMS Financial Audits, Bid Audits, Program Audits, Risk Adjustment Validation Audits, Data Validation Audits and any other CMS ad hoc or targeted audits. •Provides corrective action plans, as appropriate; ensures compliance with Federal laws, rules, regulations, manuals and transmittals pertaining to the Medicare advantage program by working with various Departments to determine the implementation and operational impact of such laws, rules and regulations on the organization. •Responsible for developing and implementing the annual compliance plan for our Medicare line of business. •Develop, implement, and lead a Medicare Compliance Committee •Ensure that delegated entities, first tier, downstream entities and independent contractors who furnish services to our members are informed of our standards of business conduct with respect to privacy, fraud, waste and abuse, and other relevant topics •Provides corrective action plans, as appropriate; ensures compliance and remains up-to-date with Federal and state laws, rules, regulations, manuals, and transmittals pertaining to the Medicare advantage program by working with various Departments to determine the implementation and operational impact of such laws, rules and regulations on the organization. •Advises the executive and leadership teams of pending changes to regulations and details their impact on the business.

Qualifications

• Master's degree or higher
• Medicare/ Healthcare Planning (5+ years)
• Do you have at least 5 years experience working as a Medicare Compliance Officer?

Benefits

Company

Our client is a Home Health Care Service company that partners with local Primary Care Doctors to continuously challenge the status quo in care provided for people with Medicare. They focus on the whole care experience. This means improved patient outcomes and it also saves money.