Medicare Compliance Officer
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Job Location:
Phoenix, NM - USA
Monthly Salary:
Not Disclosed
Posted on:
2 days ago
Vacancies:
1 Vacancy
Department:
Job Summary
Where Youll Work
Hello humankindness
Located conveniently in the heart of Phoenix ArizonaSt. Josephs Hospital and Medical Center is a 571-bed not-for-profit hospital that provides a wide range of health social and support services. Founded in 1895 by the Sisters of Mercy St. Josephs was the first hospital in the Phoenix area. More than 125 years later St. Josephs remains dedicated to its mission of caring for the poor and underserved. We are extremely proud to be a nationally recognized center for quality quaternary care medical education and research. St. Josephs includes the internationally renowned Barrow Neurological Institute Norton Thoracic Institute Cancer Center at St. Josephs Ivy Brain Tumor Center and St. Josephs Level I Trauma Center (which is verified by the American College of Surgeons). The hospital is also a respected center for high-risk obstetrics neuro-rehabilitation orthopedics and other medical services. St. Josephs is considered a sought-after destination hospital for treating the most complex cases from throughout the world. Every day approximately 20 percent of the hospitals patients have traveled from outside of Arizona and the United States to seek treatment at St. Josephs. U.S News & World Report routinely ranks St. Josephs among the top hospitals in the United States for neurology and addition St. Josephs boasts the Creighton University School of Medicine at St. Josephs and a strategic alliance with Phoenix Childrens Hospital. St. Josephs is consistently named an outstanding place to work and one of Arizonas healthiest employers. Come grow your career with one of Arizonas Most Admired Companies. Look for us on Facebookand follow us on Twitter. For the health of our community ... we are proud to be a tobacco-free campus.
Job Summary and Responsibilities
Job Summary:
The Medicare Compliance Officer (MCO) is responsible for developing implementing and overseeing the compliance program for Medicare Advantage (Part C) and Medicare Part D activities for Mercy Care Plan managed by Aetna a CVS Company. This role ensures adherence to all applicable federal and state regulations and CMS requirements safeguarding the integrity and compliance of Plan operations.
Reporting Structure:
This position will maintain day-to-day operational alignment with the Mercy Care Medicare team while holding direct reporting accountability to the Chief Executive Officer (CEO) and the Audit and Compliance Committee of the Mercy Care Plan Board of Directors.
- Provide formal reports to the Board of Directors CEO and Compliance Committee at least quarterly and more frequently as needed detailing the status of Mercy Care Plans Medicare Compliance Program implementation identification and resolution of compliance issues and oversight and audit activities.
- Oversee the development and administration of the Board of Directors annual Code of Conduct and compliance training program including program design content creation distribution tracking and ongoing maintenance to ensure full compliance with regulatory and organizational standards.
- Develop and implement programs and mechanisms that promote a culture of integrity by encouraging managers and employees to report suspected fraud waste abuse or other misconduct ensuring confidentiality and protection against retaliation.
- Respond promptly to reports of potential Medicare fraud waste or abuse (FWA) including coordinating internal investigations and developing appropriate corrective or disciplinary actions when necessary. Maintain the FWA reporting mechanism and collaborate closely with the Internal Audit Department and the Special Investigations Unit (SIU) as applicable.
- Exercise flexibility in designing and managing internal investigations (e.g. addressing suspected violations or reported issues) and implementing resulting corrective measures such as policy enhancements and disciplinary actions to ensure compliance and mitigate risk.
- Coordinate with the Plans Human Resources department (or equivalent) to ensure thorough screening of the DHHS OIG and GSA exclusion lists for all employees officers directors managers and contracted entities including first-tier downstream and related entities confirming none are listed on these exclusions.
Job Requirements
- Bachelors Other or an equivalent combination of directly related workexperience and/or education and
- Five (5) years of experience that demonstrates solid Medicare compliance program development operation and administration responsibilities
Preferred
- Registered Nurse: AZ
Knowledge Skills and Training:
- Strong Business acumen and healthcare industry
Required Experience:
Unclear Seniority
Key Skills
- Compliance Management
- Risk Management
- Financial Services
- PCI
- Banking
- Cost Accounting Standards
- Quality Systems
- Research Experience
- NIST Standards
- Securities Law
- SOX
- ISO 27000
About Company
Dignity Health provides compassionate, high-quality, affordable health care services throughout Arizona, California and Nevada. Schedule an appointment today!
