Director, Medicare Compliance - Hybrid

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.

AZ Blue offersa variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week

• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week

• Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month

• Onsite: daily onsite requirement based on the essential functions of the job

• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

Responsible for ensuring overall compliance with all Corporate and Medicare compliance activities and programs. Serves as the Medicare Compliance Officer and is the primary point of contact for the Centers for Medicare and Medicaid Services (CMS) for Medicare products.

REQUIRED QUALIFICATIONS

Required Work Experience

• 5+ years of management experience
• 7+ years of experience in corporate compliance
• 5+ years of experience in Medicare Advantage program compliance

Required Education

• Bachelor’s Degree in business, healthcare policy, judicial studies, ethics or related field

Required Licenses

• N/A

Required Certifications

• N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience

• Experience serving as Medicare Compliance Officer
• Experience leading CMS program audit readiness and response
• Experience with FDR oversight and delegated entity compliance
• Experience presenting to executive leadership, compliance committees, and governing boards
• Experience managing compliance issue investigations, corrective action plans, and regulatory reporting

Preferred Education

• Master’s Degree in business, healthcare policy, judicial studies, ethics or related field

Preferred Licenses

• N/A

Preferred Certifications

• CHC, CHPC, or similar certification

• Develops and/or maintains the comprehensive Medicare Compliance Programs and Work Plans for the organization, including responding to all compliance questions or concerns; developing and distributing compliance training programs for the organization’s employees, and First Tier, Downstream and Related Entities (FDRs)
• Reports to the Medi Sun Board and other appropriate committees on the activities of the Medicare Compliance Program
• Acts as compliance liaison for Medicare products with the Centers for Medicare and Medicaid Services (CMS), maintaining a positive relationship with the CMS Account Manager/Regional Office
• Prepares for and responds to CMS and other external audits.
• Chairs various Medicare Compliance committees for appropriate oversight
• Manages Medicare Program requirements, such as Health Plan Management System (HPMS) submissions.
• Evaluates and communicates…