<h3><b>To learn more about <a href="https://himalayas.app/companies/arkansas-blue-cross">Arkansas Blue Cross</a> and Blue Shield Hiring Policies, please click <a href="https://www.arkansasbluecross.com/company/career-opportunities/hiring-policies" rel="nofollow ugc noopener noreferrer" target="_blank">here</a>.</b></h3><h3>Job Summary</h3>The Program Manager Medicare Compliance is responsible for assisting with all Medicare Advantage (MA) compliance activities. The position manages the operations of Compliance, including components of the administration, interpretation, and enforcement of the Compliance Program and managing the regulatory affairs, prevention, detection, and correction functions of Compliance.<h3>Requirements</h3><h3>EDUCATION</h3><h3>Bachelor's degree required.</h3><h3>LICENSING/CERTIFICATION</h3><p>Certification in Health Care Compliance or pursuit of certification preferred. </p><h3>EXPERIENCE</h3><p>Minimum seven (7) years' government compliance experience in a healthcare insurance or CMS government program environment. OR applicable Masters in related field and Certified Healthcare Compliance designation with minimum five (5) years' experience.</p><p>Minimum three (3) years' direct Medicare Advantage compliance experience.</p><p>Minimum two (2) years' leadership experience (role, team lead, project management, etc.)</p><p>Strong understanding of CMS requirements and regulations related to Medicare Advantage and Medicare Part D operations and compliance.</p><p>Experience with CMS Program Audits. Financial audits, data validation audits, CMS reviews, and CMS’ HPMS modules required. </p><p>Strong knowledge of CMS regulations pertaining to compliance in a managed care health plan, and the Medicare Managed Care Manual, is a must. </p><p>Compliance experience coupled with excellent “hands-on” development, implementation, and maintenance of compliance programs, policies and procedures.</p><p>Strong understanding of the seven elements of an effective compliance program and the CMS methodology of Prevent, Detect, and Correct Knowledge of applicable legislation/regulations and responsible for departmental implementation and ongoing compliance.</p><h3>ESSENTIAL SKILLS &amp; ABILITIES</h3><h3>Oral &amp; Written Communication</h3><h3>Collaborative</h3><h3>Project Management</h3><h3>Organizational</h3><p>Ability to work with cross-functional stakeholders and external partners including state and federal regulators.</p><p>Ability to handle multiple projects at one time.</p><p>Ability to effectively present highly complex information and respond to questions from groups of managers, clients, customers, and the general public.</p><p>Ability to maintain confidentiality related to sensitive matters. Strong ethical foundation and trustworthy character.</p><h3>Skills</h3><h3>Responsibilities</h3>• Continually analyzes business needs, identify potential problems, ensure effective lines of communicating business and compliance issues, and assist