I.                    Position Summary

Position incumbent will report directly to the National Director, Health Plan Compliance.  The Administrator will assist the Director in coordinating the Health Plan’s efforts to ensure compliance with laws, regulations, and policies affecting the Medicare Advantage health plan business.   

II.                  Principal Responsibilities

Responsibilities include but are not limited to:

·         Serve as a liaison to the Centers for Medicare and Medicaid Services (CMS) in the resolution of regulatory issues.

·         Assist in the accurate communication of Medicare contractual requirements and guidance throughout the health plan, as well as the internal coordination of compliance activities.

·         Assist in CMS audit preparation of materials, including binder preparation and mock audits.

·         Assist in the development and review of policies and procedures.

·         Assist with the oversight of Policy and Procedures Oversight Committee meetings.

·         Conduct compliance investigations when reported through Compliance Hotline.

·         Conduct research on Medicare regulations.

·         Assist with specialized departmental trainings and development of training tools and presentations.

·         Work with Director to coordinate the various elements of state/federal regulatory filings, as needed.

·         Responsible for the audit and monitoring of departments for CMS audit guide elements, using CMS checklists and other tools as developed and/or provided. 

·         Assist the Director in the monitoring and oversight of third-party vendors and subcontractors responsible for various functions.

·         Coordinate with the Director in preparing status reports to senior management and periodic updates from on-site visits and/or audits.

·         Maintain highly organized and very detailed on-line and hard copy filing systems to facilitate effective, accurate responses to internal and external requests.

·         Partner with health plan staff in preparing accurate on-site visit reports and sending approved responses to CMS while working with Director to ensure any corrective action plans are sufficiently addressed by appropriate health plan departments.

·         Responsible for the review of marketing and member materials to ensure they are in compliance with CMS requirements. Oversee the Compliance SharePoint Marketing Online Review process and documentation logs and submission of materials via the CMS HPMS system.

·         Serve as the subject matter expert on Medicare Marketing Guidelines and Enrollment Guidelines.

·         Perform special projects as assigned by the Director.      

III.                Minimum Requirements and Education

·         Bachelor’s Degree preferred but will accept 3-5 years of demonstrated experience/knowledge of regulatory compliance and program management. 

·         Experience with Medicare Advantage program is preferred.

·         Individual must be trustworthy and handle matters in a confidential manner.

·         Excellent organizational capabilities with ability to work effectively as a team player. 

·         Ability to continuously interact effectively and professionally with all levels of staff.

·         Excellent written and oral communication skills.

·         Ability to handle multiple priorities/projects in a fast-paced professional environment.

·         Working knowledge of word-processing and database software.

·         Demonstrated performance in meeting time-sensitive deadlines with minimal supervision.

We offer competitive salary and excellent benefits, Including 401k, EOE

Please Apply at

http://jobs-essencehealthcare.icims.com