Medicare Compliance Officer

Hello humankindness Located conveniently in the heart of Phoenix Arizona St. Josephs Hospital and Medical Center is a 571-bed not-for-profit hospital that provides a wide range of health social and support services. Founded in 1895 by the Sisters of Mercy St. Josephs was the first hospital in the Phoenix area. More than 125 years later St. Josephs remains dedicated to its mission of caring for the poor and underserved.We are extremely proud to be a nationally recognized center for quality quaternary care medical education and research. St. Josephs includes the internationally renowned Barrow Neurological Institute Norton Thoracic Institute Cancer Center at St. Josephs Ivy Brain Tumor Center and St. Josephs Level I Trauma Center (which is verified by the American College of Surgeons). The hospital is also a respected center for high-risk obstetrics neuro-rehabilitation orthopedics and other medical services. St. Joseph’s is considered a sought-after destination hospital for treating the most complex cases from throughout the world. Every day approximately 20 percent of the hospital’s patients have traveled from outside of Arizona and the United States to seek treatment at St. Joseph’s.U.S News & World Report routinely ranks St. Josephs among the top hospitals in the United States for neurology and neurosurgery. In addition St. Josephs boasts the Creighton University School of Medicine at St. Josephs and a strategic alliance with Phoenix Childrens Hospital.St. Josephs is consistently named an outstanding place to work and one of Arizonas healthiest employers. Come grow your career with one of Arizonas Most Admired Companies.Look for us on Facebook and follow us on Twitter. For the health of our community ... we are proud to be a tobacco-free campus.

Develops operates and administers the regulatory compliance program for both Medicare Advantage (Part C) and Medicare Part-D plan activities for Mercy Care Plan. Mercy Care Plan is managed by Schaller Anderson an Aetna Company. Reports directly to the Plan CEO and the Audit and Compliance Committee of the Board of Directors of SCHN.

• Develops and monitors the implementation of and compliance with Medicare policies and procedures through the creation and implementation of a work plan.
• Reports, at least on a quarterly basis, or more frequently as necessary, to the board of directors, president and/or CEO, and compliance committee, on the status of Mercy Care Plan's Medicare compliance program implementation, the identification and resolution of potential or actual instances of noncompliance, and the Plan's oversight and audit activities.
• Creates and coordinates, or appropriately delegates, educational training programs to ensure that the Plan's officers, directors, managers, employees, and other individuals working on the Medicare program are knowledgeable of Mercy Care Plan's compliance program; its written standards of conduct, policies, and procedures; and the applicable statutory, regulatory, and other requirements.
• Ensures that first tier entities, downstream entities, and related entities, particularly those involved in sales and marketing activities, are aware of and follow the requirements for Medicare sales and marketing activities.
• Briefs the compliance committee and governing body on the status of compliance training.
• Develops and implements methods and programs that encourage managers and employees to report suspected fraud and other misconduct without fear of retaliation.
• Maintains the compliance reporting mechanism and closely coordinates with the internal audit department and the SIU, where applicable.
• Responds to reports of potential instances of Medicare fraud, waste or abuse, including the coordination of internal investigations and the development of appropriate corrective or disciplinary actions, if necessary. To that end, the Medicare Compliance Officer should have the flexibility to design and coordinate internal investigations (e.g., responding to reports of problems or suspected violations) and execute any resulting corrective action (e.g., making necessary improvements to policies and practices and taking appropriate disciplinary action).
• Coordinates personnel issues with the Plan's Human Resources office (or its equivalent) to ensure that the DHHS OIG and GSA exclusion lists have been checked with respect to all employees, officers, directors and managers as well as first tier entities, downstream entities, and related entities are not included on such lists.
• Reports any potential fraud or misconduct related to the Medicare program to CMS, its designee and/or law enforcement in accordance with Section 50.2.8.2 of this Chapter.
• Maintains documentation, for each report of potential fraud, waste or abuse received through any of the reporting methods (i.e. hotline, mail, in-person), which describes the initial report of non-compliance, the investigation, the results of the investigation, and all corrective and/or disciplinary action(s) taken as a result of the investigation as well as the respective dates when each of these events and/or actions occurred and the names and contact information for the person(s) who took and documented these actions.
• Oversees the development and monitoring the implementation of corrective action plans.
• Coordinates potential fraud investigations/referrals with the SIU, where applicable, and the appropriate MEDIC and facilitate any documentation or procedural requests that the MEDIC makes of the Medicare plan. Similarly, the Medicare Compliance Officer should collaborate with other health plans, state Medicaid programs, Medicaid Fraud Control Units (MCFUs), commercial payers, and other organizations when a fraud, waste or abuse issue is discovered to involve multiple parties.

Dignity Health now offers an Education Benefit program for benefit-eligible employees.  This program provides debt relief and student loan assistance to help you achieve your goals. Full-time employees can receive up to $18,000 over five years, while part-time employees can receive up to $9,000. While you’re busy impacting the healthcare industry, we’ll take care of you with benefits that include health/dental/vision, FSA, matching retirement plans, paid vacation, and adoption assistance.

MINIMUM

Bachelor's Degree or an equivalent combination of directly related work experience and/or education required.

Five (5) years of experience that demonstrates solid Medicare compliance program development, operation and administration responsibilities required.

Working knowledge of all Microsoft office products required. Strong business acumen and healthcare industry required.

PREFERRED

RN

AZ RN license