Hispanic Alliance for Career Enhancement
Medicare Compliance Consultant
Hispanic Alliance for Career Enhancement, Phoenix, Arizona, United States
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Position Summary
The
Medicare Compliance Consultant
is a compliance role that supports the compliance program activities and deliverables of a Medicare managed care organization. In partnership with - and under the direction of - the health plan, Medicare Compliance Officer, and other team members, this position will help develop and maintain systems and processes that demonstrate the principles of an effective compliance program and promote compliant and ethical behavior in our Medicare Advantage health plans. Responsibilities
Maintain an in-depth working knowledge of the health plan's contractual, regulatory, and program policy related obligations as a Medicare Advantage organization. In partnership with other senior members of the team, assist with the oversight and monitoring activities used to evaluate the levels of compliance with the Medicare Part C and Part D regulations. Provide support for the elements and compliance department responsibilities required under the Medicare Compliance Program, which include (but are not limited to) meeting attendance, capturing meeting minutes, OIG (Office of Inspector General)/GSA (General Services Administration) screening of board members, monitoring compliance mailbox, tracking and assisting responses to compliance inquiries, and serving as a resource to health plan staff. Effectively escalate identified risks, concerns, and other issues through appropriate channels. Maintain the systems and tools used to track, monitor, review, and communicate Medicare Advantage Part C and D contract deliverables. Review, interpret, and distribute regulatory guidance materials, and track required health plan implementation timeframes. Support external and internal audit processes in conjunction with senior members of the team; including (but not limited to) project management and tracking of required audit deliverables. Utilize systems unique to job functions, including standard-issue software such as Microsoft products and compliance specific tools; maintain system documentation. Maintain positive, productive relationships with internal and external constituents to effectively communicate and influence ethical and compliant outcomes. Other duties as assigned. Required Qualifications
2+ years of experience in regulatory compliance in Medicare Advantage Managed Care. Preferred Qualifications
Previous experience with Medicare Part C and D regulations and Medicare Advantage Managed Care. Previous project management experience. Previous experience in auditing. Strong written and verbal communication skills. Detail-oriented. Education
Bachelor's degree or equivalent experience (high school diploma or GED + 4 years of relevant experience). Compensation and Benefits
The typical pay range for this role is $43,888.00 - $102,081.00. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. We offer a comprehensive and competitive mix of pay and benefits, including affordable medical plan options, a 401(k) plan, an employee stock purchase plan, and no-cost programs for all colleagues. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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The
Medicare Compliance Consultant
is a compliance role that supports the compliance program activities and deliverables of a Medicare managed care organization. In partnership with - and under the direction of - the health plan, Medicare Compliance Officer, and other team members, this position will help develop and maintain systems and processes that demonstrate the principles of an effective compliance program and promote compliant and ethical behavior in our Medicare Advantage health plans. Responsibilities
Maintain an in-depth working knowledge of the health plan's contractual, regulatory, and program policy related obligations as a Medicare Advantage organization. In partnership with other senior members of the team, assist with the oversight and monitoring activities used to evaluate the levels of compliance with the Medicare Part C and Part D regulations. Provide support for the elements and compliance department responsibilities required under the Medicare Compliance Program, which include (but are not limited to) meeting attendance, capturing meeting minutes, OIG (Office of Inspector General)/GSA (General Services Administration) screening of board members, monitoring compliance mailbox, tracking and assisting responses to compliance inquiries, and serving as a resource to health plan staff. Effectively escalate identified risks, concerns, and other issues through appropriate channels. Maintain the systems and tools used to track, monitor, review, and communicate Medicare Advantage Part C and D contract deliverables. Review, interpret, and distribute regulatory guidance materials, and track required health plan implementation timeframes. Support external and internal audit processes in conjunction with senior members of the team; including (but not limited to) project management and tracking of required audit deliverables. Utilize systems unique to job functions, including standard-issue software such as Microsoft products and compliance specific tools; maintain system documentation. Maintain positive, productive relationships with internal and external constituents to effectively communicate and influence ethical and compliant outcomes. Other duties as assigned. Required Qualifications
2+ years of experience in regulatory compliance in Medicare Advantage Managed Care. Preferred Qualifications
Previous experience with Medicare Part C and D regulations and Medicare Advantage Managed Care. Previous project management experience. Previous experience in auditing. Strong written and verbal communication skills. Detail-oriented. Education
Bachelor's degree or equivalent experience (high school diploma or GED + 4 years of relevant experience). Compensation and Benefits
The typical pay range for this role is $43,888.00 - $102,081.00. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. We offer a comprehensive and competitive mix of pay and benefits, including affordable medical plan options, a 401(k) plan, an employee stock purchase plan, and no-cost programs for all colleagues. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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