DescriptionSHIFT: Day Job
Build the Possibilities. Make an extraordinary impact.
Responsible for directing foundational and strategic compliance responsibilities with consistent excellence that support the team and management.
How you will make an impact:
- Focused on Medicare Parts C & D Appeals and Grievances (MCAG) - directs projects, initiatives, regulatory sanctions, executive-sponsored initiatives, regulatory audits or exams, internal audits, accreditations, on-site reviews, risk assessments; audit planning, conducting mock audits, conducting audit training, managing audit evidence preparation, assessing audit preparedness.
- Leads compliance monitoring to identify process gaps, validate compliance levels, map processes, draft corrective actions/remediation plans, oversee implementation of corrective actions, prepare reports/presentations.
- Leads complex investigations and documents findings.
- Develops strategic plans, makes recommendations to leadership; designs/implements annual compliance plan.
- Develop strong relationships with key leaders to identify and address compliance risks and failures and manage action plans designed to fully mitigate risk(s).
- Maintains current knowledge of CMS and other pertinent regulations, and government enforcement initiatives
- Develops and implements training and communication plans; manages and leads scheduled and ad-hoc compliance projects; provides and delivers compliance consultation services to the business unit.
- Develop strong relationships with regulators, especially CMS.
- Provides overall business advisory support in Medicare Parts C and D Appeals and Grievances (MCAG) regulatory guidance
- Requires a BA/BS and minimum of 8 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
- Experience in Medicare Parts C and D Appeals & Grievances strongly preferred
- Strong leadership skills and ability to motivate/coach other staff strongly preferred.
- MS/MBA/JD or professional designation preferred.
- Excellent verbal and written communication skills.
- Strong attention to detail.
- Solid problem solving and time management skills.
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 [email protected] for assistance.
Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.