CareFirst BlueCross BlueShield · 2 weeks ago
Compliance Officer - MD Medicaid (Hybrid)
Baltimore, MD
Full-time
Hybrid
Senior Level, Lead/Staff
$141K/yr - $261K/yr
8+ years expCareFirst BlueCross BlueShield is seeking a Compliance Officer to oversee compliance under the Medicaid contract and regulatory requirements. This role involves establishing compliance programs, managing audits, and ensuring staff training on Medicaid compliance, while collaborating with various departments to maintain compliance standards.
Health CareNon ProfitService Industry
No H1B
Responsibilities
Direct accountability for establishing an effective compliance program based on the seven core elements of compliance
Directs the activities related to the design, development, implementation and maintenance of compliance programs across all major functional areas and vendors for Medicaid within the division
Ensures internal departments understand and implement CMS and applicable state rules, policies and regulations
Responsible for risk assessment activities for internal departments
Collaborates with Corporate Compliance to support all Medicaid audits, reviews and examinations conducted by internal audit staff
Directs and oversees internal Medicaid risk assessments, to ensure that appropriate staff are fully aware of objectives and that they can produce and maintain suitable records, reports, and files which adequately document planning, execution, and reporting for all relevant activities pertaining to the regulations, including documentation and storage of policies and procedures
Develops and implements internal compliance monitoring procedures
Ensures conclusions, findings and recommendations for improvement or corrective action are appropriately presented to management staff for review, and verify that all findings are accurate, complete and objective
Maintains a database of contractual requirements and status of compliance that is auditable and trackable
Works with leadership to ensures non-compliant activities are corrected and all compliance related changes are tracked
Monitors, assesses and reports significant matters to senior management
Point of contact for Corporate Compliance, Legal and Mandates teams to manage compliance of operational teams with the division
Directs a staff of training professionals in the design, development, presentation and evaluation of effective, appropriate and progressive compliance training programs in collaboration with Corporate Compliance Office and Legal
Participates in and develops training and education regarding Medicaid Compliance throughout the business unit including the development of electronic learning devices, if applicable, in concert with, if applicable, corporate audit, HRD and the Corporate Compliance Office
Ensures that all Medicare and/or Medicaid requirements for training are met by internal departments and first tier, downstream and related entities
Directs the activities resulting in uniform, compliant methods and practices for executing daily activities in order to measure and improve associate skills that have a direct effect on customer satisfaction
Provides guidance on changes to the law that may impact training and education and require updates to Medicaid Compliance training programs
Directs all activities related to contractual performance
Ensures that associates receive detailed, clear and professional performance feedback, in adherence to Policies, SOPs and business protocols
Independently validates performance through focused audits and controls
Develops individual performance measures that support customer satisfaction initiatives
Additional responsibilities include the development of uniform methods and practices in order to measure and improve associate skills and systems performance
Prepares status reports communicating compliance activities, identification and correction of problems, trends identified, recommendations and analysis of effectiveness of the Medicaid Compliance programs
Collaborates with the Medicaid Compliance officers, as well as the Corporate Compliance team to assure that compliance activities across the organization meet federal, state and organization standards
Participates in Enterprise Risk Management activities with Enterprise Risk Management and the Corporate Compliance Integrated Risk Management teams
Qualification
Required
Bachelor's Degree in business, healthcare, related area OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience
8 years progressively responsible corporate compliance, Medicare/Medicaid or government work experience and/or related experience, inclusive of at least 5 years Medicare Part C and/or Medicaid compliance experience
3 years Management experience
Preferred
Master's Degree
Juris Doctor
Benefits
Comprehensive benefits package
Various incentive programs/plans
401k contribution programs/plans
Company
CareFirst BlueCross BlueShield
CareFirst. It’s not just our name. It’s our promise.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Ja'Ron Bridges
Interim President and Chief Executive Officer
Doba Parushev
Vice President, Healthworx Ventures
Recent News
2025-10-02
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