Medicare Compliance Manager
4 days ago
Gold Coast Health Plan is seeking a highly skilled Medicare Compliance Manager to join our team. As a key member of our Compliance Department, you will be responsible for developing, administering, and overseeing the Medicare Compliance Program and initiatives in alignment with our overall D-SNP strategy.
Key Responsibilities- Develop and implement compliance projects and program activities focusing on integrating regulatory requirements, industry standards, and organizational policies for Medicare, Medi-Cal, and Knox Keene.
- Manage and oversee the compliance program to ensure that Gold Coast Health Plan and its first-tier, downstream, and related entities consistently operate in accordance with all applicable federal and state laws, regulations, and regulatory guidance.
- Collaborate with the Government Affairs Department to maintain compliance with CMS, DHCS, and DMHC requirements, including GCHP's Knox Keene license and contractual obligations with regulatory agencies.
- Work with the Compliance Department, Operations Oversight Department, D-SNP leadership, and other internal stakeholders to address compliance issues, develop corrective action plans (CAPs), 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.
- Bachelor's degree in Healthcare Administration, Business Administration, or a related field.
- Minimum of 5 years of experience in healthcare compliance, with a focus on Medicare compliance and regulations.
- Medicare part C and D expertise, including demonstrable knowledge of Medicare regulations, guidelines, audit protocols, and processes.
- Master's degree in Healthcare Administration, Business Administration, or a related field.
- Prior experience with CMS audits (program, timeliness, and data validation) as well as DHCS and DMHC compliance requirements.
- Broad and detailed knowledge of health plan operations and best practices.
- Experience with Corporate Integrity Agreements.
Gold Coast Health Plan offers a competitive salary and benefits package, as well as opportunities for professional growth and development. If you are a motivated and experienced compliance professional looking for a new challenge, we encourage you to apply for this exciting opportunity.
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