Manager, Compliance-Third Party Engagement (Northfield, IL)

Job Summary

The Manager, Compliance-Third Party Engagement is responsible for managing assigned activities related to US Government Program Integrity, including but not limited to Health Plans Supplemental and Value Based Programs, Medicare Advantage FDR Oversight, Accreditation Oversight, and Medicare, Medicaid, & Commercial Insurance Payer Audits. This individual interacts with Legal, RCM, PAC Health Plans, Health Plan Business Partners, Customer Service, and External Upstream and Down Stream Entities to ensure compliance with Federal and State Regulations. In addition, the Manager, Compliance manages a team of Compliance Specialists.

Job Description

MAJOR RESPONSIBILITIES

• Manage and document all comprehensive external payer audit responses, including coordination of response, analyzing results, determining trends, development of risk mitigation controls
• Ensure compliance with existing regulations as set forth by CMS, Medicare Advantage, State Medicaid and Federal and State Laws that govern matters related to US Government Programs. Monitor, analyze, interpret, and communicate regulatory changes. Lead and oversee workplan development and execution to respond to changing regulations.
• Lead appeal efforts including formulation of appeal/grievance reason and argument logic, identification of submission materials for resolution, tracking and trending.
• Reduce organization risk by identifying, designing, implementing, and revising as necessary process, systems, and risk mitigation strategies for assigned risk areas
• Active participant in the US Government Program Integrity risk assessment and gap analysis including execution of assigned mitigation plan activity
• Identifies, develops, and implements improved and standardized compliance policies and procedures
• Develops and delivers education and supporting tools
• Analyze and Assess Downstream vendor compliance program effectiveness
• Develop and monitor assigned performance improvement quality assurance and corrective action plans
• Management responsibilities include Day-to-day operations of a group of employees; Interpret and execute policies for departments/projects and develops, recommends and implements new policies or modifications to existing policies; Provide general guidelines and parameters for staff functioning; Hiring staff, recommending pay increases, performing performance reviews, training and development of staff, estimating personnel needs, assigning work, meeting completion dates, interpreting and ensuring consistent application of organizational policies.

MINIMUM JOB REQUIREMENTS

Education

• Bachelor’s degree.

Work Experience

• At least 3 years compliance, regulatory or audit experience at a senior professional level.
• At least 3 years of experience developing and/or implementing corporate compliance programs.
• Experience evaluating information to determine compliance with standards, laws, and regulations.

Knowledge / Skills / Abilities

• Working knowledge of Commercial, Medicare and Medicaid Regulations
• Working knowledge of payer coverage guidelines
• Experience working with cross-functional teams and facilitating teams to identify and implement  solutions to complex programs
• Experience analyzing and reporting data in order to identify issues, trends, or exceptions to drive improvement of results and find solutions
• Working knowledge of Medicare Advantage Compliance Program Requirements
• Experience directly managing people including hiring, developing, motivating, and directing people

PREFERRED JOB REQUIREMENTS

Education

• Graduate education in degree program (completed degree preferred) in business, law, or related field.

Certification / Licensure

• Certified compliance professional.

Work Experience

• Compliance experience in the medical device, supply or pharmaceutical industry.
• Global/international compliance experience.

Medline Industries, LP, and its subsidiaries, offer a competitive total rewards package, continuing education & training, and tremendous potential with a growing worldwide organization.

The anticipated salary range for this position:

$110,240.00 - $165,360.00 Annual

The actual salary will vary based on applicant’s location, education, experience, skills, and abilities. This role is bonus and/or incentive eligible. Medline will not pay less than the applicable minimum wage or salary threshold.

Our benefit package includes health insurance, life and disability, 401(k) contributions, paid time off, etc., for employees w