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Compliance Manager in Remote at Beacon Health Options

Date Posted: 11/16/2018

Job Snapshot

Job Description

About The Position:

The Beacon Health Options Regional Compliance Manager will work closely with the Corporate Medicare Compliance Officer on processes and systems to monitor Medicare Managed Care (Medicare Advantage and Medicare-Medicaid Plans), corporate, and with governmental requirements. This individual will analyze business requirements, provide research and regulatory guidance, and advise internal business units to ensure full compliance and minimize risk. The Regional Compliance Manager tracks federal and state regulations and Centers for Medicare and Medicaid Services (CMS) guidance that might affect the organization's policies and procedures and works with members of the compliance team and operational areas to design policies and training as appropriate. The Regional Compliance Manager will be a compliance subject matter resource to functional departments and a member of the enterprise-wide compliance team. The Regional Compliance Manager serves as the lead for monitoring of compliance activities and effectiveness for one or more service/engagement centers and corresponding region(s). 

This position can be located in Norfolk, VA; Woburn, MA; Boston, MA; Latham, NY; Morrisville, NC

Position Responsibilities:

  • Maintain current knowledge of applicable federal and state laws including up-to-date knowledge of developments in Medicare, Medicaid, Medicare Advantage, CMS, and with legislative and regulatory implications for the Behavioral Health and Wellness industry, and the Beacon Health Options portfolio of products and services.
  • Initiate, facilitate and promote activities and communications that foster compliance awareness, knowledge, and effectiveness.
  • Work with Corporate Medicare Compliance Officer to develop and implement general compliance training and policies and procedures. Conduct and document trainings.
  • Work with operational leadership to provide adequate information to ensure that they and their staff have the requisite information and knowledge of contractual and regulatory requirements to carry out their responsibilities in a lawful and ethical manner.
  • Assist account/operational management in responding to health plan and CMS audits and provide technical assistance to improve performance. 
  • Participate in the development and implementation of ongoing compliance monitoring and risk assessment for assigned service/engagement center(s).
  • Conduct internal operational compliance audits and prepare audit reports based on findings.
  • Support external compliance audits as directed.
  • Participate in the annual review and update of national policies and procedures related to access to Medicare Advantage and disclosure of PHI.
  • Analyze data as it pertains to CMS/Part C reporting through the use and development of analytical, tracking, and data management tools.
  • Participate on strategic project teams, special initiatives, and performs other duties as assigned.

Position Requirements:

  • Education: Bachelor’s degree in a healthcare, communications, business management or related field. 
  • Certifications: Preference will be given to candidates with certifications related to their professional training, such as, Certified in Healthcare Compliance (CHC)®, or Certified Compliance & Ethics Professional (CCEP)®.

Relevant Work Experience: Minimum of two years of experience in healthcare compliance.  A combination of claims, provider relations, customer service, compliance and/or appeals and grievances functions in a Medicare Advantage /delegated Medicare Advantage environment required.

  • In-depth knowledge of the Medicare health plan compliance, ODAG protocols and Part C reporting.
  • Comprehensive knowledge of compliance procedures.
  • Experience with MediRegs or other regulatory research platform.
  • Proven ability to communicate complex subjects to all levels of associates, management and external contacts.
  • Excellent communication, negotiation and conflict resolution skills.
  • Strong technical and business writing skills demonstrating the ability to write reports and business correspondence.
  • In-depth knowledge of the healthcare industry including elements of compliance plans requirements.
  • Ability to interact with others to identify opportunities for improvement and provide resolutions for identified issues.
  • Experience creating and implementing a healthcare compliance program.
  • Proficient computer skills in Microsoft products: Outlook, Word, Excel and PowerPoint.​

To Apply:

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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled