Medicaid Compliance Officer | Aetna


Job Description

The Medicaid Compliance Officer position promotes and enforces compliance with state/federal laws and regulations and related-company policies (including the Aetna/CVS Health Code of Conduct) affecting Aetna businesses and encouraging high business standards in order to advance company objectives, benefit the company’s customers, employees and shareholders, and protect the company’s reputation.
Responsibilities include: auditing, investigating, training/education and enforcement, ongoing consultation on compliance issues impacting businesses, interfacing with industry groups and regulators on compliance with laws and regulators, monitoring and reporting on adherence to compliance controls, recommending and helping businesses to implement compliance controls.

Fundamental Components

  • This role will work closely with the CEO, as well as, members of the legal department building successful relationships with stakeholders, client, state/federal authorities and other parties as necessary.
  • Oversees compliance activities in support of a large or complex business group and/or manages teams responsible for managing audits and other regulatory exams, inquiries or reporting.
  • Works closely with management to drive compliance as a core competency and integrate compliance into business plans, scorecards, metrics and processes; removes barriers to implementation. This is partnership with the health plan to focus on understanding scope of business and partner with plan to achieve business needs while maintaining compliance.
  • Assures the timely implementation of all state and federal legislation and regulations applicable to assigned business areas.
  • Ensures that compliance risks are addressed and corrective actions are taken, as appropriate; Assists business units with development and promulgation of appropriate compliance controls/corrective actions.
  • Oversees or ensures the development of policies and procedures needed in response to new or existing laws or Company policies.
  • Monitors ongoing compliance with the policies and procedures within the business group
  • Conducts investigations of compliance deviations or failures.
  • Promotes compliance reviews and risk assessments
  • Promotes and enforces Aetna/CVS Health’s Code of Conduct
  • Promotes compliance awareness, education and training
  • Assists with communicating the Company’s business conduct, integrity and compliance messages
  • Identifies and analyzes significant legislative initiatives and impact on business operations
  • Establishes education programs and provides and/or promotes continuing training & education
  • Assures compliance direction is aligned with segment business strategies
  • Develops standards of performance and related metrics.

Required Qualifications

5 years experience in a regulatory compliance position in managed care healthcare, insurance or financial services

Preferred Qualifications

Knowledge of Medicaid/ Medicare
Masters or Law degree
Bachelor’s degree required.
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.


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