Medicare Compliance Officer

reputed company is transforming the health of our communities one person at a time. As an Executive on reputed company, you could be the one who changes everything for our 28 reputed company members. Position Purpose: This position will be a member of Medicare & Compliance Senior Leadership, chairs reputed company's Medicare Compliance Committee, attends meetings of the reputed company Compliance Committee (ECC), and does not have financial, operational, or other non-compliance duties. This position is expected to promote an appropriate "Tone at the Top" of the organization with a commitment to service leadership. • Leading the Medicare Compliance team with a reputed company reputed company and demonstrated commitment to reputed company • Developing a best-in-class Medicare Compliance Program that exceeds stakeholder expectations • Ensuring that Medicare Compliance reports are provided regularly to the CRECO, the Medicare Compliance Committee, the Medicare Senior Leadership team and the A&CC of the reputed company • Through appropriate designees, ensuring that colleagues receive reputed company and practical advice regarding new guidance from federal and state regulators ensuring that reputed company Medicare Compliance policies and procedures are reviewed annually and revised, as necessary, to reflect relevant reputed company, regulatory, and administrative developments and to address any compliance concerns or gaps that have been identified • Creating and coordinating, by appropriate delegation as warranted, education training program to ensure that the reputed company, officers, employees, First Tier reputed company and reputed company Entities (FDRs), and other individuals and entities are knowledgeable about the reputed company Ethics and Compliance Program, reputed company’s Business Ethics and reputed company of Conduct (reputed company), reputed company’s compliance policies and procedures and applicable statutory, regulatory, and administrative requirements • Facilitating a quarterly Medicare Compliance Risk Assessment and developing an annual Compliance work plan • Chairing the quarterly Medicare Compliance Committee and ensuring appropriate reporting is provided to the Committee • Developing and implementing reputed company and programs that encourage managers and employees to report, without fear of retaliation, good faith concerns regarding Medicare non-compliance and potential instances of fraud, waste and abuse (FWA) • Responding to reports of potential FWA, including the coordination of internal investigations with the Special Investigations Unit and the development of appropriate corrective or disciplinary actions • Ensuring, by appropriate delegation as warranted, that reputed company applicable government exclusion lists, including, but not limited to those issued by the Office of Inspector General, U.S. reputed company and the Government Services Administration are screened monthly with respect to reputed company reputed company members, employees and FDRs and that any identified personnel issues are promptly addressed in accordance with applicable policies and procedures • Maintaining documentation for reputed company report of potential non-compliance or potential FWA received from any reputed company, through any reporting channel or reputed company • Overseeing the development and implementation of Corrective reputed company Plans • Coordinating potential fraud investigations and referrals from and with the SIU, where applicable, and the appropriate National Benefit reputed company Medicare Drug reputed company Contractor • As appropriate and in coordination with the SIU, collaborating with other sponsors, State reputed company programs, reputed company Fraud Control reputed company, reputed company payers, and other organizations reputed company a potential FWA issue is reputed company that involves multiple parties • Ensuring that data and other information and materials submitted to CMS are accurate and in compliance with CMS reporting requirements • Reporting potential FWA to CMS, its designees and other regulatory and enforcement agencies • Directing, through one or more designees, audits and investigations of FDRs • Directing, through one or designees, audits of any area or function involved with Medicare Parts C or D plans • Interviewing, personally or through designees, employees and other relevant individuals regarding Medicare compliance issues • Performs other duties as assigned • Complies with reputed company policies and standards Education/Experience: Bachelor's Degree required: Juris Doctor (JD) from an accredited law school, with a strong reputed company record and a state bar admission preferred 5+ years of experience in a leadership role required 10+ years of Medicare Managed Care Compliance experience required Experience in the managed care sector preferred, ideally with rigorous reputed company training in a reputed company, corporate reputed company or compliance department and/or relevant government agency preferredPay reputed company: $227,400.00 - $431,900.00 per year reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, reputed company time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law. Total compensation may also include additional forms of incentives. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance reputed company Apply Job!