Resp & Qualifications
PURPOSE: As a member of the Federal and Consumer Government Programs (FSCGP) leadership team, the position of Director, Medicare/Medicaid Compliance is accountable for directing all aspects related to the design and execution of training curriculums, quality assurance programs and the overall state of compliance for the Medicare, Medicare Advantage and Medicaid products. Works closely with operational teams, Corporate Compliance, Mandates and Legal departments to resolve complex issues with inter-related legal and Medicare and/or Medicaid compliance aspects. This position will direct all aspects related to the design and execution of Medicare and Medicaid compliance training programs through education, training, investigation activities and the detection of possible violation of the federal and state statutes, regulations or contractual terms impacting Medicare and Medicaid programs. Additionally, this position will be responsible for the start-up phase evaluation of operational compliance. In fulfilling the duties of this position, the Director, Medicare/Medicaid Compliance, will be responsible for ensuring training curriculums and quality assurance programs are in compliance with the contract between CareFirst and The Centers of Medicare and Medicaid Services (CMS). Additionally, the incumbent will create and maintain an effective compliance program that meets the seven core requirements and and fosters a culture of compliance.
Under the direction of the Senior Vice President, Federal & State Consumer Government programs the principle duties and accountabilities include, but are not limited to, the following:
SUPERVISORY RESPONSIBILITY: This position’s direct reports includes up to four Managers and total of 4-6 direct reports. Provides oversight of 20+ indirect reports.
COMPETENCIES: This position requires the following competencies to perform at a superior level:
Conceptual Grasp/Managing Change: Effectively copes with change and isn’t upset with vague situations; comfortably shifts focus and handles risk and uncertainty
Problem Solving: Strategic thinking, facilitating, negotiating, conflict management, influence, coaching, empowerment, delegation, problem solving, planning, teamwork development.
Business Acumen: A basic understanding of business processes and financial control procedures, methods and philosophies coupled with strong analytical reasoning, and problem-solving skills are highly desired. Drive, commitment, self-confidence, insight, judgment, integrity, ethics, continuous personal improvement, responsiveness, timeliness, learning capacity, flexibility and adaptability, ability to meet deadlines.
Effective Commnication/ Building Relationship: Individual must possess strong communication skills, and must be able to effectively present complex information both orally and written. Individual must be team oriented and demonstrate flexibility in terms of moving freely from one project to another.
Integrity: Exercises high standards of business conduct; is trustworthy, is intellectually honest; lives the values of the organization
Bachelor’s degree required, graduate degree preferred, 5 years leadership experience plus 7- 10 years of progressively responsible corporate compliance, Medicare or government work experience and/or related experience, inclusive of at least 5 years Medicare Part C compliance experience.
Qualified candidates should have demonstrated experience in designing, developing and implementing organizational programs and initiatives that focus on increasing quality, productivity and customer satisfaction. Experience in developing and designing performance management and continuous improvement systems to align with corporate and divisional goals and objectives is a must. Must have the ability to manage multiple priorities, meet project goals and deadlines and coordinate and integrate processes and procedures to ensure consistency across the division. Ability to effectively communicate orally and in writing, develop and deliver large group presentations, and design, generate and analyze reports for Senior Management is required. Must be capable of developing partnerships and relationships with internal and external colleagues, clients and vendors to ensure that operations programs are aligned with corporate and strategic objectives. Experience in establishing benchmarking and best practice research processes is a plus.
Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. 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.
Department: Federal & State Consumer Government Programs
Equal 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.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Please apply before: 10/11/2019
Federal Disc/Physical Demand
Note: 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.
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