ICON Consultants, LP · 2 days ago

Compliance Manager

United States

Contract

Remote

Senior Level

5+ years exp

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Responsibilities

Legal and Compliance support services: Work closely with the Legal, Government Contracts, and Compliance departments to ensure proper interpretation of new rules and regulations.

Rules and regulations: Ensure implementation of federal and state requirements for Medicare and Medicaid for health plan content and for assigned defined projects and programs. Lead impact assessments and define work plans to ensure compliance when policies and regulations change. Lead the department in ongoing work related to policy and procedure documentation, revision, and maintenance.

Internal/external audits: Collect and validate data/sample/documentation requests; review preliminary findings with stakeholders and prepare/deliver responses.

CAPs: Work with SMEs to document the CAP and ensure resolution; lead the team and track deliverables to ensure timely completion.

KPI's: Report on department policy and compliance KPIs. Manage the strategic direction for the Compliance Practices Oversight team, ensuring the Marketing team is enabled to achieve and maintain consistent compliance across all requirements.

Leadership: Lead a team of people. Establish the strategic direction, mission, and vision for the Compliance Practices Oversight team, ensuring that Marketing functions are enabled to achieve and maintain consistent compliance across all requirements.

Other related duties may be assigned as needed.

Qualification

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Medicare rulesRegulations knowledgeCorrective action plansAuditManaged healthcare operationsComplianceMedicareMedicaid regulations interpretationProcess developmentProof-readingQuality controlMicrosoft ApplicationsDatabasesCenters for MedicareMedicaid ServicesHealth Plan Management SystemProblem-solvingCritical thinkingAnalyticalInterpersonalCommunicationLeadershipDetail orientedOrganized

Required

Knowledge of Medicare rules and regulations

Experience with corrective action plans (CAPs)

Audit experience

5+ years experience with managed healthcare operations or compliance, interpreting Medicare and Medicaid regulations and requirements

3+ years process development/improvement experience

3+ years people leadership

Strong analytical skills

Strong problem-solving and critical thinking skills

Highly organized and detail oriented with proof-reading and quality control skills

Strong interpersonal, written and verbal communication skills; ability to communicate and facilitate communication with individuals at various levels within the organization and with external vendors

Strong technical skills using Microsoft Applications (i.e., Outlook, Word, Excel, and PowerPoint) and other databases and tools as needed

Previous experience working with the Centers for Medicare and Medicaid Services (CMS) Health Plan Management System (HPMS)