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CommonSpirit Health

CommonSpirit Health is a nonprofit organization that is on a mission to improve people’s health while making “the healing presence of God known.” The orga

Manager Medicare Compliance

Location

United States

Posted

88 days ago

Salary

0

Seniority

Lead

No structured requirement data.

Job Description

Manager Medicare Compliance

CommonSpirit Health

Role Description The Medicare Compliance Officer (MCO) is responsible for developing, implementing, and overseeing the compliance program for Medicare Advantage (Part C) and Medicare Part D activities for Mercy Care Plan, managed by Aetna, a CVS Company. This role ensures adherence to all applicable federal and state regulations and CMS requirements, safeguarding the integrity and compliance of Plan operations. - Maintain day-to-day operational alignment with the Mercy Care Medicare team. - Hold direct reporting accountability to the Chief Executive Officer (CEO) and the Audit and Compliance Committee of the Mercy Care Plan Board of Directors. - Provide formal reports to the Board of Directors, CEO, and Compliance Committee at least quarterly, detailing the status of Mercy Care Plan’s Medicare Compliance Program implementation, identification and resolution of compliance issues, and oversight and audit activities. - Oversee the development and administration of the Board of Directors’ annual Code of Conduct and compliance training program. - Develop and implement programs that promote a culture of integrity by encouraging reporting of suspected fraud, waste, abuse, or other misconduct. - Respond promptly to reports of potential Medicare fraud, waste, or abuse (FWA), including coordinating internal investigations and developing corrective or disciplinary actions. - Maintain the FWA reporting mechanism and collaborate with the Internal Audit Department and the Special Investigations Unit (SIU). - Design and manage internal investigations and implement resulting corrective measures. - Coordinate with the Plan’s Human Resources department to ensure thorough screening of the DHHS OIG and GSA exclusion lists for all employees and contracted entities. Qualifications - Bachelors or an equivalent combination of directly related work experience and/or education. - Five (5) years of experience in Medicare compliance program development, operation, and administration. Requirements - Registered Nurse: AZ (preferred). - Strong business acumen and healthcare industry knowledge.

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