Compliance Officer

Medicaid Compliance DirectorThis role is accountable for directing all aspects related to the monitoring of performance under the Medicaid contract and regulatory requirements. Reporting to the CEO, the incumbent works closely with operational teams to resolve complex issues with inter-related legal and Medicaid compliance aspects. The position includes direct accountability for establishing an effective compliance program based on the seven core elements of compliance. Collaborates with Corporate Compliance to support all Medicaid audits, reviews, and examinations conducted by internal audit staff. Directs and oversees internal Medicaid risk assessments, to ensure that appropriate staff are fully aware of objectives and that they can produce and maintain suitable records, reports, and files which adequately document planning, execution, and reporting for all relevant activities pertaining to the regulations. Maintains a database of contractual requirements and status of compliance that is auditable and trackable. Works with leadership to ensure non-compliant activities are corrected and all compliance related changes are tracked. Monitors, assesses, and reports significant matters to senior management. Directs a staff of training professionals in the design, development, presentation, and evaluation of effective compliance training programs. Provides guidance on changes to the law that may impact training and education and require updates to Medicaid Compliance training programs. Directs the activities resulting in uniform, compliant methods and practices for executing daily activities in order to measure and improve associate skills that have a direct effect on customer satisfaction. Prepares status reports communicating compliance activities, identification and correction of problems, trends identified, recommendations, and analysis of effectiveness of the Medicaid Compliance programs. Collaborates with the Medicaid Compliance officers, as well as the Corporate Compliance team to assure that compliance activities across the organization meet federal, state, and organization standards. Participates in Enterprise Risk Management activities with the Enterprise Risk Management and the Corporate Compliance Integrated Risk Management teams.This position manages people.Education Level: Bachelor's Degree in business, healthcare, related area OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.Experience: 8 years progressively responsible corporate compliance, Medicare/Medicaid or government work experience and/or related experience, inclusive of at least 5 years Medicare Part C and/or Medicaid compliance experience. 3 years Management experience.Preferred Qualifications: Master's Degree, Juris DoctorKnowledge, Skills and Abilities (KSAs): Understanding of business processes and financial control procedures, methods and philosophies coupled with strong analytical reasoning, and problem-solving skills are highly desired. Knowledge of compliance program development and maintenance. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.Salary Range: $140,720 - $261,212The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business considerations. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).Department: Medicare Compliance OfficeEqual Employment Opportunity: CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.Where To Apply: Please visit our website to apply: www.carefirst.com/careersFederal Disc/Physical Demand: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.Physical Demands: The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.Sponsorship in US: Must be eligible to work in the U.S. without Sponsorship