Compliance Manager Medicare

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Your career starts now. We are looking for the next generation of healthcare leaders.

At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Role Overview: 

The Manager, Compliance provides support in the oversight of all operating division and subsidiary compliance functions and the implementation of compliance policy, process, and control activities. This position will monitor the execution of operational changes required by regulations and guidelines.  The primary focus is on managing the audit team.  Will work with internal audits, Medicare, and Medicaid, as well as regulatory audits.  

Work Arrangement:

• This is a remote position within the United States working East Coast hours 

Responsibilities:

• Assists in the development of compliance methodologies and monitors the effectiveness of compliance-related processes
• Assist in the identification of gaps, weaknesses, and deficiencies and/or business productivity/efficiency opportunities
• Partners with local and corporate counterparts to review and assess objectives that ensure compliance with local plans and corporate policies and procedures
• Implements and monitors metrics and ensures accurate reporting of compliance information
• Ensure that local compliance-related issues and risks are reported
• Conduct routine and ad-hoc compliance assessments/research
• Assist in the training of local compliance associates
• Must be able to operate independently with minimal management oversight and be able to manage competing priorities and deadlines that are subject to frequent change. Must possess and exercise excellent professional judgment in all interactions

Education/Experience:

• Bachelor’s Degree in Business, Social Science, or relevant field required
• Minimum of 3 years in a managed healthcare environment, including experience in the areas of compliance oversight is a must
• Minimum of 3 years of supervisory experience is a must, as this role will have a team of 4-5 Analysts reporting to them
• Knowledge of compliance concepts and practices (strategies, control activities, information analysis, reporting, and communication)  
• Strong analytical and research skills, able to synthesize information to provide practical solutions to accomplish meaningful results
• Self-motivated with demonstrated project management skills
• Extensive experience with CMS audits and comprehensive knowledge of DSNP contracts is highly preferred
• Certified in Healthcare Compliance preferred
   

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.