Job Description

Chief Compliance Officer, Medicare Advantage

CommuniCare Advantage, a member of CommuniCare Health Services ,is currently recruiting a Chief ComplianceOfficer for our Medicare Advantage plan.

The Chief Compliance Officer ensures compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation; recommending opportunities to strengthen the internal control structure.

The Chief Compliance Officer is responsible for the internal auditing, documenting, and reporting of all internal auditing activities as well as functioning as the contact for all external auditing activities of the organization’s trading partners. This position ensures all documentation is timely delivered and properly maintained, auditing activities are documented and follow-up is prompt and accurate.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Conduct and document internal audits of all business units to identify and correct areas of non-compliance.
• Organize, document and participate in all external audits. Identify compliance issues that require follow-up or investigation.
• Develop, implement, and document a master compliance auditing log. Disseminate written policies and procedures related to compliance activities.
• Create and maintain a historical corrective action log to be used for internal auditing.
• Meet work standards by following production, productivity, quality, and customer-service standards; resolving operational problems; identifying work process improvements.
• Prepare for audit by researching materials; formulating a plan of action.
• Ensure compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation; recommending opportunities to strengthen the internal control structure
• Complete audit work papers and memorandums by documenting audit tests and findings.
• Communicate audit progress and findings by preparing reports; providing information in meetings.
• Support external auditors by coordinating information requirements.
• Provide management reports by collecting, analyzing, and summarizing management information.
• Update job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations.
• Enhance compliance department and organization reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.
• Study both existing and new legislation, enforce policies and advise management on necessary actions to make sure company complies with local, state and federal legal requirements
• Stay current on industry standards.
• Support special projects and other tasks as assigned.

QUALIFICATIONS :

• Bachelor’s degree in healthcare or equivalent work experience.
• Minimum three years in managed health care.
• Minimum two years in health care compliance.
• Strong knowledge of industry standards and guidelines.
• Outstanding written and verbal communication abilities
• Familiarity with computer and necessary software
• Detail-oriented and well-organized
• Strong decision-making and problem-solving skills
• Ability to foster strong relationships
• Research and reporting skills
• Strong statistical analysis skills
• Managed Care Experience preferred.

As a CommuniCare employee you will enjoy competitive wages and PTO plans. We offer full time employees a menu of benefit options from life and disability plans to medical, dental, and vision coverage from quality benefit carriers. We also offer 401(k) with employer match and Flexible Spending Accounts.

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Chief Compliance Officer • Baltimore, Maryland

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