Medicare Compliance Manager
2 months ago
**Salary Range**: $114,138 - $171,207
**Job Summary**
The Medicare Compliance Manager, plays a key role within the Compliance Division, reporting directly to the Chief Compliance Officer (CCO) or alternatively the Compliance Director. This role is responsible for providing leadership and guidance of CenCal Health’s compliance program, ensuring adherence to regulatory requirements, industry standards, and organizational policies for Medicare, Medi-Cal, and Knox Keene. The Medicare Compliance Manager possesses a deep knowledge of Medicare regulations, strong leadership skills, and a commitment to promoting a culture of compliance throughout the organization.
**Duties and Responsibilities**
- Co-develop, implement, integrate, and manage the Medicare compliance program, ensuring it aligns with regulatory requirements and industry best practices. Ensure integration of the Medicare compliance program with CenCal Health’s existing compliance framework.
- Provide guidance and leadership to cross-functional teams involved in Medicare, Medi-Cal, and Knox Keene compliance activities, including but not limited to Legal, Operations, Clinical, and Quality Assurance teams.
- Collaborate with the Regulatory Compliance Department to maintain compliance with CMS, DHCS, and DMHC requirements, including CenCal Health’s Knox Keene license and contractual obligations with regulatory agencies.
- Collaborate with the Audits, Monitoring, and Oversight (AMO) Department within the Compliance Division to conduct regular assessments and audits of Medicare processes, systems, and documentation to identify compliance risks and areas for improvement.
- Collaborate with the Audits, Monitoring, and Oversight (AMO) Department and internal stakeholders to address compliance issues, develop corrective action plans, and monitor progress towards resolution.
- Responsible for daily monitoring of CMS’s Health Plan Management System (HPMS), required DHCS reporting, DMHC filings, and other required regulatory submissions.
- Responsible for ensuring that all required CMS, DHCS, DMHC and other regulatory reports, including any required attestations, are submitted within required timeframes.
- Co-develop for Medicare and D-SNP and integrate with the current process for communicating regulatory information in a clear and concise manner and implementing solutions to support internal and external operational and compliance activities.
- Consult on investigations for any incoming compliance complaints of potential non-compliance. Collaborate with SIU regarding potential Fraud, Waste and Abuse, as needed.
- Partner to ensure that the DHHS OIG and Government Services Administration (GSA) exclusion lists have been checked with respect to all employees, governing body members, and FDRs monthly and coordinating any resulting personnel issues with the sponsor’s Human Resources, Security, Legal or other departments as appropriate.
- Keep abreast of changes in Medicare, Medi-Cal, and Knox Keene regulations, guidance, and enforcement priorities.
- Co-develop and implement training programs and educational materials on Medicare, Medi-Cal, and Knox Keene compliance topics to employees at all levels of the organization. New training programs should integrate with the organization’s training program.
- Participate in compliance-related committees, working groups, and initiatives to promote a culture of integrity, ethics, and compliance.
**Knowledge/Skills/Abilities**
- In-depth knowledge of Medicare regulations, including but not limited to Medicare Advantage (Part C), Prescription Drug Plans (Part D), and Medicare fee-for-service (Parts A and B), as well as Medi-Cal and Knox Keene requirements.
- In-depth knowledge of health care compliance programs and how to implement and maintain the OIG’s seven elements of a compliance program.
- Strong leadership and management skills, with the ability to influence and collaborate effectively across functional areas and levels of the organization.
- Excellent communication and interpersonal skills, with the ability to convey complex regulatory concepts clearly and concisely to diverse audiences.
- Analytical mindset with the ability to identify compliance risks, develop mitigation strategies, and monitor effectiveness of controls.
- Commitment to upholding ethical standards, integrity, and professionalism in all aspects of compliance-related activities.
**Education and Experience**
- Bachelor's degree in Healthcare Administration, Business Administration, Legal Studies, or a related field or an equivalent combination of education and experience.
- Advanced degree (e.g., JD, MPH, MBA) preferred.
- Minimum of 5 years of experience in healthcare compliance, with a focus on Medicare compliance and regulations.
- Certification in Healthcare Compliance (CHC), Certified in Healthcare Privacy and Compliance (CHPC), or similar credentials are strongly preferred.
We have other current jobs related to this field that you can find below
-
Senior Medicare Contracts Analyst
3 months ago
Santa Cruz, United States Central California Alliance for Health Full timeWe have an opportunity to join the Alliance as a Senior Medicare Contracts Analyst, internally referenced as Senior Provider Services Contracts Analyst supporting the brand new team focused on recruitment and expansion of our provider network for the Provider Services Department. The Senior Provider Services Contracts Analyst will manage the full lifecycle...
-
Compliance Manager
1 month ago
Santa Barbara, United States BrightStar Care of Santa Barbara County Full timeRN – Compliance ManagerAs a leader in providing high-quality healthcare services to individuals in the comfort of their homes, we are seeking a dynamic and experienced Registered Nurse (RN) to join our team as a Compliance Manager. Responsibilities:Provide administrative direction and support for our Joint Commission Accredited Agency. Work closely with...
-
Compliance Manager
1 month ago
Santa Barbara, United States BrightStar Care of Santa Barbara County Full timeRN – Compliance ManagerAs a leader in providing high-quality healthcare services to individuals in the comfort of their homes, we are seeking a dynamic and experienced Registered Nurse (RN) to join our team as a Compliance Manager. Responsibilities:Provide administrative direction and support for our Joint Commission Accredited Agency. Work closely with...
-
Compliance Analyst/Officer
4 weeks ago
Santa Barbara, United States Umbra Full timeUmbra builds next-generation space systems that observe the Earth in unprecedented fidelity. Our mission: Deliver global omniscience. To stay ahead of climate change, geopolitical risk, and other major crises and issues, we need a global understanding of what is changing, where, and how fast. Umbra provides easy access to the highest quality commercial...
-
Employee Benefits Account Manager
3 months ago
Santa Barbara, United States Demboski & Chapman Financial and Insurance Solutions Full timeJob DescriptionJob DescriptionDescription:Your primary role is to ensure the management of the group employee benefits, individual health insurance and Medicare senior supplement coverages. This role entails servicing, educating clients, administrative work of front stage experience deliverables and back stage templates/processes to explain concepts. You...
-
EMR Project Manager
4 weeks ago
Santa Barbara, United States The Spine and Orthopedic Center Full timeJob DescriptionJob DescriptionEHR/EMR Project Manager: Busy orthopedic office has a full-time opening for an EHR Project Manager. Position is Monday-Friday from 8AM-5PM in-house. Remote or freelance candidates will not be considered.Job Summary: Primary responsibilities will include the development and improvement of our electronic medical records (EMR)...
-
Small Group Benefits Manager
1 month ago
Santa Barbara, United States Demboski & Chapman Financial and Insurance Solutions Full timeJob DescriptionJob DescriptionJoin our team as an Employee Benefits Account Manager, where you'll manage group employee benefits, individual health insurance, and Medicare senior supplement coverages. This dynamic role involves educating clients, handling administrative tasks, and balancing new business with servicing needs. You'll work closely with...
-
Clinic Manager
2 weeks ago
Santa Barbara, United States California Retina Consultants Full timeClinic Manager The Clinic Manager for California Retina Consultants oversees the daily operations and administration of the clinic, ensuring the delivery of high-quality patient care and efficient functioning of the practice. They are responsible for managing staff, coordinating schedules, overseeing patient flow, implementing policies and procedures, and...
-
Clinic Manager
5 days ago
Santa Barbara, United States California Retina Consultants Full timeClinic Manager The Clinic Manager for California Retina Consultants oversees the daily operations and administration of the clinic, ensuring the delivery of high-quality patient care and efficient functioning of the practice. They are responsible for managing staff, coordinating schedules, overseeing patient flow, implementing policies and procedures, and...
-
Customer Service Representative
1 month ago
Santa Ana, United States Ivonne Welch Medicare Plans Full timeIvonne Welch Insurance Agency is seeking experienced, bilingual Customer Service Representatives to join our dedicated team and help provide quality service over the phone to our mostly Spanish-speaking, Medicare-age clients and their families. Our ideal candidates are highly motivated, detail-oriented, customer service professionals who are looking for a...
-
Component Compliance Engineer IV
3 months ago
Santa Barbara, United States KARL STORZ SE & Co. KG Full timeAt KARL STORZ, we believe in not just creating jobs but building careers. As a family-run company, we understand the value of long-term relationships and actively work on promoting them. When YOU grow, we grow. Lead component discussions with EEs globally, and play a key role in establishing global standards and processes. Lead multi-functional teams to...
-
Customer Service Representative
3 months ago
Santa Ana, United States Ivonne Welch Medicare Plans Full timeBenefits: 401(k) Dental insurance Health insurance Paid time off Vision insurance Ivonne Welch Insurance Agency is seeking experienced, bilingual Customer Service Representatives to join our dedicated team and help provide quality service over the phone to our mostly Spanish-speaking, Medicare-age clients and their families. Our...
-
Component Compliance Engineer IV
1 month ago
Santa Barbara, United States Karl Storz Endoscopy-America Full timeJOB SUMMARY: Lead component discussions with EEs globally, and play a key role in establishing global standards and processes. Lead multi-functional teams to solve complex vendor-related component issues. Selects, and qualifies components used in the companys technology. Act as technical interface between component/production suppliers and development...
-
Component Compliance Engineer IV
3 weeks ago
Santa Barbara, United States Karl Storz Endoscopy-America Full timeJOB SUMMARY: Are you ready to apply Make sure you understand all the responsibilities and tasks associated with this role before proceeding. Lead component discussions with EEs globally, and play a key role in establishing global standards and processes. Lead multi-functional teams to solve complex vendor-related component issues. Selects, and qualifies...
-
Director of Nursing
2 months ago
Santa Barbara, United States Carrillo Surgery Center Full timeJob DescriptionJob DescriptionJob Summary:Carrillo Surgery Center (CSC) has an opening for a Director of Nursing. A state-of-the-art facility located in beautiful Santa Barbara, CSC is a AAAHC accredited and Medicare certified outpatient surgery center specializing in spine, pain management, and neurology. The position will be responsible for the overall...
-
EMR Developer
4 weeks ago
Santa Barbara, United States The Spine and Orthopedic Center Full timeJob DescriptionJob DescriptionEHR Developer: Busy orthopedic office has a full-time opening for an EHR Developer. Position is Monday-Friday from 8AM-5PM in-house. Remote or freelance candidates will not be considered.Job Summary: Primary responsibilities will include the development and improvement of our electronic medical records (EMR) system.Job...
-
Revenue Cycle Analyst
3 days ago
Santa Barbara, United States Online Technical Services Full time $26 - $27Job DescriptionJob DescriptionRevenue Cycle Analyst- medical billingWe have a contract need for a Revenue Analyst for a 13-week assignment.The job is located in Santa Barbara and is a hybrid role where some onsite work is required.Monday-Friday 8-5Revenue Cycle Analyst is expected to have:Clear understanding of billing rules for all payersClear understanding...
-
Payroll Compliance Manager
1 month ago
Rancho Santa Margarita, United States Park West Full timeThe Payroll Compliance Manager is responsible for overseeing all payroll processing tasks to ensure timely and accurate compliance with company policy and Federal and State Regulations.Role and Responsibilities· Processes all semi-monthly and weekly payroll posting for over 1,500+ employees· Ensure earning and deduction codes are set up with proper tax...
-
Payroll Compliance Manager
4 weeks ago
Rancho Santa Margarita, United States Park West Full timeThe Payroll Compliance Manager is responsible for overseeing all payroll processing tasks to ensure timely and accurate compliance with company policy and Federal and State Regulations.Role and Responsibilities· Processes all semi-monthly and weekly payroll posting for over 1,500+ employees· Ensure earning and deduction codes are set up with proper tax...
-
Legal Compliance Manager
1 month ago
Santa Fe Springs, United States Sigmaways Inc Full timeWe are looking for a Contract Manager for our direct client who will work with the Legal & Compliance team and various business representatives to support contract and project management functions of the company’s smart logistics (SL) business.This position will provide comprehensive legal support, focusing on contract management & other legal...
