Description
SHIFT: Day Job
SCHEDULE: Full-time
Location - Remote Nationwide
Be part of an extraordinary team.
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving high-performance culture that empowers you to make an impact?
The Beacon Health Options (Beacon) Medicare Compliance Consultant Senior will work closely with the Beacon Medicare Compliance Officer to monitor compliance with Medicare Advantage and Medicare-Medicaid Plan requirements.
Consultant will advise internal business units on Medicare operational compliance, reporting and audits (CMS Program Audits (ODAG/SARAG) and Part C Data Validation).
Essential Duties and Responsibilities Primary duties may include, but are not limited to: - At the most senior advanced level, report, communicate, research laws, regulations, requirements, regulatory audits and/or exams. - Provide senior level analytical support to projects, initiatives, regulatory audits or client oversight audits, internal audits,on-site reviews and, risk assessments. - Utilize systems unique to job functions, including standard-issue software such as Microsoft products including SharePoint; maintain system documentation, serve as subject matter expert, train users of system, contribute to system design, oversight or maintenance. - Apply critical thinking to formulate strategies and concepts that drive results, persuade and influence others, adapt to change, and manage conflict.
Qualifications
- Requires a BA/BS and minimum of 5 years health care, regulatory, ethics, compliance or privacy experience; or any combination of education and experience, which would provide an equivalent background. - Ability to travel may be required.
Preferred Qualifications: - In-depth knowledge of Medicare health plan operations, reporting and audits including CMS Program Audits (ODAG/SARAG protocols) and Part C technical specifications. - A combination of appeals and grievances, claims, clinical, customer service, provider relations, and/or compliance functions in a Medicare Advantage /delegated Medicare Advantage environment required. - Preference will be given to candidates with certifications such as Certified in Healthcare Compliance (CHC)R or Certified Compliance & Ethics Professional (CCEP)R
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.
Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.
REQNUMBER: PS74267-California
