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Regional Medicare Compliance Manager (VA, MA, NC, Remote) in Remote at Beacon Health Options

Date Posted: 2/16/2019

Job Snapshot

Job Description

General Summary:  The Beacon Health Options Regional Medicare Compliance Manager will work closely with the Corporate Medicare Compliance Officer on processes and systems to monitor compliance with Medicare Managed Care (Medicare Advantage and Medicare-Medicaid Plans) requirements. This individual will analyze business requirements, provide research and regulatory guidance, and advise internal business units on Medicare operational compliance, reporting and audits (CMS Program Audits/ODAG/SARAG and Part C Data Validation). The Regional Medicare Compliance Manager tracks federal 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 Medicare Compliance Manager will be a compliance subject matter resource to functional departments and a member of the enterprise-wide corporate compliance team. The Regional Medicare 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 Remote or located in [a Beacon office in]: Chesapeake, VA; Woburn, MA; Boston, MA; Morrisville, NC

  • Maintain current knowledge of applicable federal rules, regulations and sub-regulatory guidance including up-to-date knowledge of developments in Medicare Advantage, legislative and regulatory implications for the Behavioral Health and Wellness industry, and the Beacon Health Options portfolio of Medicare managed care products and services.
  • Initiate, facilitate and promote activities and communications that foster Medicare compliance awareness, knowledge, and effectiveness.
  • Work with Corporate Medicare Compliance Officer to develop and implement Medicare compliance training and policies and procedures. Conduct and document trainings for assigned region(s) or operational area(s).
  • 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).
  • May conduct internal operational compliance audits and prepare audit reports based on findings.
  • May 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.

Minimum Qualifications:

  • Education:  Bachelor’s degree in a healthcare, communications, business management or related field. 
  • Licensures: none required
  • 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 appeals and grievances, claims, clinical, customer service, provider relations, and/or compliance functions in a Medicare Advantage /delegated Medicare Advantage environment required.
  • Skills:  Ideal candidate will demonstrate:
  • In-depth knowledge of the Medicare health plan operations, reporting and audits including ODAG and/or SARAG protocols and Part C technical specifications and CMS Program Audits.
  • Comprehensive knowledge of the seven elements of an effective compliance program, as set forth in the applicable Federal regulations governing Part C.
  • Experience with MediRegs or other regulatory research platform preferred.
  • Proven ability to communicate complex subjects to all levels of associates, management and external contacts.
  • Ability to interact with others to identify opportunities for improvement and provide resolutions for identified issues.
  • Experience creating and/or 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