Sr Mgr, Medicare Compliance

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, required to be onsite at least once per week

• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month

• Onsite: daily onsite requirement based on the essential functions of the job

• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per month.

This role requires work and residency within the state of Arizona. It is also classified as a People Leader (see Workability category).

PURPOSE OF THE JOB

· The Senior Manager, Medicare Compliance will manage the day-day-day activities of the Medicare Compliance department, which engages in monitoring the company’s compliance with requirements pertaining to Medicare Advantage and Prescription Drug plan, and Medicare Supplement product lines and segments. Serves as the secondary point of contact for Centers for Medicare and Medicaid Services (CMS) for Medicare products. Responsible for ensuring

overall compliance with all Medicare compliance activities and programs. Will report directly to the Staff Vice President of Corporate and Medicare Compliance, and Medicare Compliance Officer.

REQUIRED QUALIFICATIONS

1. Required Work Experience

· 8 years of experience with government or compliance, or legal issues

2. Required Education

· Bachelor’s Degree in compliance, health administration, legal studies, or other related field of study

3. Required Licenses

· N/A

4. Required Certifications

· N/A

PREFERRED QUALIFICATIONS

1. Preferred Work Experience

· 10 years of experience with compliance, government programs or legal issues in a healthcare industry

2. Preferred Education

· Master’s Degree in business or healthcare field of study

3. Preferred Licenses

· N/A

4. Preferred Certifications

· Advanced compliance professional, audit, or legal training

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

• Manage the day-to-day operations of the department.
• Control and direct workflow to staff in a timely manner, including internal and external compliance reviews / audits.
• Oversee internal, initial and final compliance review/audit reports. Maintain records of compliance investigation/audit activity and track to ensure all work papers within each investigation/review/audit are accurately controlled.
• Administer, interpret, and maintain current working knowledge of the required AZ Blue systems, procedures, forms and manuals as related to the assigned area of responsibility.
• Responsible for the review, update and accuracy of Compliance documentation, computer files, policies and procedures related to the department goals and objectives.
• Keep staff informed of new or updated standards, systems, procedures, forms and manuals through staff meetings and verbal and written communications.
• Direct, evaluate, define, and improve the quality, quantity and timeliness standards to achieve individual and department performance goals as defined within department guidelines.
• Develop and maintain competent staff to carry out assigned functions.
• Provide guidance, motivation, and encouragement to staff, conduct performance evaluations, identify and coordinate training needs, and make determinations regarding disciplinary actions.
• Plan, monitor and coordinate direct activities needed to support corporate goals and objectives.
• Evaluate and make recommendations in regard to employment decisions.
• Consult and coordinate with various internal departments, external Blue Plans or business partners and government agencies where appropriate for all Medicare compliance activities and programs as wel