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Dignity Health · 2 days ago

Medicare Compliance Officer

Phoenix, AZ

Full-time

Onsite

Senior Level

$43.10/hr - $64.11/hr

5+ years exp

Dignity Health is a healthcare organization that is seeking a Medicare Compliance Officer responsible for developing and overseeing the compliance program for Medicare Advantage and Part D activities. The role involves ensuring adherence to federal and state regulations, reporting to the Board of Directors, and promoting a culture of integrity within the organization.

Health CareHospitalMedicalNon Profit

Responsibilities

Provide formal reports to the Board of Directors, CEO, and Compliance Committee at least quarterly, and more frequently as needed, detailing the status of Mercy Care Plan’s Medicare Compliance Program implementation, identification and resolution of compliance issues, and oversight and audit activities

Oversee the development and administration of the Board of Directors’ annual Code of Conduct and compliance training program, including program design, content creation, distribution, tracking, and ongoing maintenance to ensure full compliance with regulatory and organizational standards

Develop and implement programs and mechanisms that promote a culture of integrity by encouraging managers and employees to report suspected fraud, waste, abuse, or other misconduct, ensuring confidentiality and protection against retaliation

Respond promptly to reports of potential Medicare fraud, waste, or abuse, (FWA) including coordinating internal investigations and developing appropriate corrective or disciplinary actions when necessary. Maintain the FWA reporting mechanism and collaborate closely with the Internal Audit Department and the Special Investigations Unit (SIU), as applicable

Exercise flexibility in designing and managing internal investigations (e.g., addressing suspected violations or reported issues) and implementing resulting corrective measures, such as policy enhancements and disciplinary actions to ensure compliance and mitigate risk

Coordinate with the Plan’s Human Resources department (or equivalent) to ensure thorough screening of the DHHS OIG and GSA exclusion lists for all employees, officers, directors, managers, and contracted entities, including first-tier, downstream, and related entities, confirming none are listed on these exclusions