Manager, Government Program Compliance – Risk Adjustment

Role Overview

• Evaluate Government Program (Medicare and Medicaid) regulations, guidance and contracts.
• Assess the risk these items present with respect to HCSC government contracts.
• Manage direct reports and provide oversight of operational compliance.
• Ensure adherence to federal/state/local laws, regulations, and contractual obligations.
• Develop policies, conduct monitoring, manage risk, and liaise with regulatory agencies.
• Identify risks and issues of noncompliance and develop mitigation strategies.
• Collaborate with Corporate Compliance and business personnel, as well as HCSC management and governmental agencies to implement controls and processes.

Requirements

• Bachelor’s Degree and five (5) years’ experience in healthcare compliance OR nine (9) years’ experience in health plan, regulatory compliance or risk management.
• One year of leadership/supervisory experience.
• Experience communicating and building relationships with internal business units and/or various external governmental agencies.
• Strong critical thinking, risk assessment, and mitigation abilities.
• Ability to influence processes to achieve results.
• Excellent verbal and written communication skills.
• Ability to work independently and be a self-starter.
• Organizational, project management, analytical and decision-making skills.
• PC proficiency to include MS Teams, Word, PowerPoint and Excel as well as Workday.

Benefits

• health and wellness benefits
• 401(k) savings plan
• pension plan
• paid time off
• paid parental leave
• disability insurance
• supplemental life insurance
• employee assistance program
• paid holidays
• tuition reimbursement
• annual incentive bonus plan