PDP Compliance Consultant - Omaha, NE or Remote
|Responsible for providing oversight, coordination and conducting internal and delegated entity audits for Medicare and Health related products to ensure the Company's plan(s) meets the regulatory and compliance requirements of federal and state laws. Provides recommendations to the business areas to ensure compliance and mitigate risk. Supports the Company's compliance investigations program and activities by overseeing, identifying, evaluating and implementing processes to mitigate potentially adverse compliance and regulatory actions.
WHAT YOU'LL DO:
- Provides guidance, consultation and support to the Company's Medicare and Health related business area and its products as it relates to compliance activities and accountabilities. Provides technical assistance and training to business units within the Plan including external entities.
- Directs and facilitates audits and monitoring reviews of internal business departments and delegated entities involved in the delivery and/or administration of Medicare plans and Health related products for compliance with the Center for Medicare and Medicaid Services (CMS).
- Assists in managing the detection, prevention, and correction of fraud, waste and abuse for the Company's Medicare and Health related Plan(s).
- Develops and updates compliance audit instruments and protocols to align with CMS and other regulatory requirements.
- Prepares and presents reports based on internal audit results to senior management committees, including recommendations for corrective action. Oversees and ensures resolution of findings and maintains records of audits and follow-up of actions taken.
- Analyzes and presents audit reports from delegated internal and external entities.
- Bachelor's degree and seasoned knowledge and experience with CMS requirements and regulations related to Medicare and Health products related operations and compliance; with at least 3-5 years experience with Managed Care Organization or Health Plan.
- Seasoned knowledge of relevant Medicare regulatory resources.
- Strong knowledge of and experience in interpreting industry laws, regulations, legal opinions, and guidance related to Medicare and health related products with the ability to identify, interpret and apply regulatory related issues and activities.
- Knowledge of and experience in Medicare and health related products compliance and risk management monitoring practices and methodologies.
- Excellent written and verbal communication skills.
- Personal computer skills to include various software packages, including word processing, spreadsheet, electronic mail and presentation, and compliance systems/databases.
- Ability to work independently with strong organizational skills; self-motivated and directed, adaptable, team focused and detail-oriented.
- Demonstrated experience and knowledge of Managed Care payment methodologies
- Demonstrated experience and knowledge of Prescription Drug Plan Audits
- Demonstrated knowledge and experience with CMS Program Audits
- Demonstrated knowledge and experience with State Department of Insurance Audits
- Health Care Compliance Certification (e.g. CHC, CHPC, CHRC)
WHAT WE CAN OFFER YOU:
- A diverse workplace where associates feel a sense of belonging
- A organization that feels like a small, close-knit community and has the strength of a Fortune 500 company
- Tuition reimbursement, training and career development
- Competitive salary, incentives, 401(k), flexible work schedules and a healthy amount of time off
If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact a Human Resources Representative at 1-800-780-0304. We are available Monday through Friday 7 am to 4:30 pm CST we will reply within 24 hours.
Mutual of Omaha and its affiliates are an Equal Opportunity /Affirmative Action Employer. Qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
To All Recruitment Agencies: We do not accept unsolicited agency resumes and we are not responsible for any fees related to unsolicited resumes.