Aetna Medicare Senior Compliance Lead in San Diego, California
Req ID: 45540BR
The Medicare Senior Compliance Lead must ensure that the requirements of an effective Medicare Compliance program are met as expressed by the Centers for Medicare and Medicaid Services (CMS) in Chapters 9&21. The Senior Compliance lead must have specialized expertise in compliance, business, analytical and communication skills to support, manage and help develop compliance strategies, programs and processes to promote compliant and ethical behavior, meet regulatory obligations and prevent, detect and mitigate compliance risks. The Senior Compliance Lead will perform the oversight of the compliance program as it relates to Medicare risk adjustment and work closely with business operations leadership to provide risk assessments of current and proposed business activities related to Medicare risk adjustment to ensure that the all elements of a Medicare Compliance program are achieved and maintained.
Key attributes include:
() The distribution and validation of regulatory alerts, performance of auditing and monitoring, evaluating risks and ensuring documentation (e.g. policies and procedures, etc.) is appropriate to demonstrate an effective Medicare Compliance program. () This position promotes compliance with CMS regulations and related-company policies, including Aetnas Code of Conduct.
(*) Maintains an effective Compliance program, including, but not limited to, risk assessment, auditing and monitoring, effective communication and training
(*) Prepares highly complex reports and manages highly complex audit/monitoring activities.
(*) Leads highly complex compliance business process reviews and corrective actions
(*) Maintains current working knowledge and expertise in Medicare Compliance with a strong focus on Medicare risk adjustment requirements
(*) Participates in governance activities for the Medicare risk adjustment program
(*) Builds and maintains positive, productive relationships with internal constituents at the most senior and regulatory organizational levels, and is able to remove significant barriers, drive decision-making and influence ethical and compliant outcomes at all organizational levels necessary to accomplish goals.
(*) Conducts activities, including monitoring and auditing as outlined in Medicare Compliance Work Plan; proposes corrective action where necessary and monitors implementation of such corrective action
Exhibits the following behaviors:
(*) Anticipate and respond to future risk situations
(*) Strong Acumen of Medicare Compliance, FDR requirements and Medicare risk adjustment
(*) Leadership skills
(*) Apply expert knowledge to mitigate risk
(*) Demonstrate critical thinking
(*) Drive and execute strategy
(*) Promote collaboration among stakeholders
(*) Institutionalize Medicare compliance as a core competency
(*) Strong auditing skills
(*) Effective communication
(*) 8 + years of work experience with a minimum of 3-5 years in Medicare Compliance or experience working with Medicare Compliance.
(*) Medicare Risk Adjustment process experience required.
(*) BA or BS degree in Healthcare and or related field required.
(*) Certified Professional Coder (CPC) or Certified Coding Specialist required.
(*) Certified Professional Medical Auditor (CPMA) preferred.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Legal/Compliance - state/federal legislation implementation/7-10 Years
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
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Job Function: Legal