Manager Medicare Compliance
Job ID: 92085 Date posted: November 08, 2018
- Sharp HealthPlan
- Management Jobs
- Day Job
- Manages the development, implementation, compliance and maintenance of Medicare Part C and D policies, procedures and programs.
- Ensures internal departments understand and implement Center for Medicare & Medicaid Services (CMS) and Department of Managed Health Care (DMHC) rules, policies, and regulations.
- Responsible for delegated oversight and audit activities for internal departments and first tier, downstream and related entities.
- Develops and implements Medicare compliance training programs.
- Tracks and analyzes state and federal rules and regulations regarding Medicare Advantage plans.
- Monitors industry best practices and makes recommendations for organizational policy and procedure change that will result in compliance.
- Interacts effectively with various internal and external departments to provide assistance and information.
- Efficiently and effectively documents information and activities so they can be tracked, trended and utilized for compliance verification and process improvement.
- Promotes the satisfaction, development and productivity of Medicare Compliance staff.
- Participates as part of, and in support of, a management team that works collaboratively to ensure the success of Sharp Health Plan’s goals, objectives, and strategic initiatives.
- Bachelor’s degree in related field
- 3 to 5 years’ of compliance experience within the health care industry
- Working knowledge of Medicare Advantage regulations, resources and processes
- Experience designing, conducting and monitoring compliance audits
- Knowledge of health plan operations and issues
- Strong knowledge of compliance principles, practices, and procedures
- Strong leadership and management skills
- Excellent organizational and interpersonal skills
- Excellent business acumen and writing skills
- Exceptional diplomacy skills to effectively resolve issues under sometimes tense and stressful circumstances
- Readily adaptable to the changing needs of the business; able to manage multiple priorities; tolerance for ambiguity
- Master’s degree or Juris Doctorate
Sharp HealthCare is proud to be an Equal opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, gender identity, transgender status, sexual orientation, protected veteran status or any other protected class.
“Sharp invests in the physical safety of its employees, unlike any other company I have worked with. They also are proactive in offering educational meetings that are relevant to the job we do. Management is fair and flexible with requested time off and there are plenty of opportunities to pick up extra shifts.”