- Ensures organization is compliant with all aspects of the Medicare, Medicaid, and other applicable compliance program requirements defined by the Center for Medicare and Medicaid Services (CMS) and applicable state Medicaid agencies, both with respect to internal operations and vendor solutions. Serves as the primary point of contact for and lead facilitator of regular meetings with CMS Account Manager.
- Oversees accurate and timely data submission and reporting to regulators of government programs. Responsible for ensuring timely and accurate responses are provided to regulators and/or auditors in relation to general inquiries, corrective actions, and necessary deliverables.
- Manages the preparation and review of annual compliance training materials, company intranet articles and/or other training and education materials. Oversees continuous readiness activities, audit support and coordination activities, and remediation activities, related to all Medicare, Medicaid, and regulatory audits.
- Facilitates and supports the annual Compliance Program Effectiveness (CPE) audit and serves as business owner of relationship with external auditors selected to perform the audit.
- Provides operational areas with compliance support and guidance related to Medicare, Medicaid, and GPO requirements and facilitates organizational response to incidents of noncompliance. Performs the annual Compliance Program Effectiveness (CPE) Assessment and develops and implements annual compliance work plan.
- Establishes and maintains performance metrics and provides regular performance dashboards, report-outs of significant matters, and compliance updates.
- Ensures that processes are in place to identify new laws, regulations, sub-regulatory guidance, and contractual requirements applicable to government programs lines of business; distributes new requirements to staff and business partners responsible for or impacted by implementation, and monitors progress of implementation.
- Analyzes the regulatory environment and legal requirements applicable to Medicare, Medicaid, and other government regulated programs and identifies risk areas.
- Serves as government programs compliance subject matter expert in support of growth and expansion initiatives.
- Performs other duties as assigned.
- Bachelor’s degree or equivalent combination of experience and education
- Five years’ experience
- Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
- Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
- Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
- Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
- Frequent keyboard use/data entry.
- Occasional bending, stooping, kneeling, squatting, twisting and gripping.
- Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
- Rare climbing.