Compliance Manager

Now hiring a Compliance Manager with a Medicare Compliance background!

The Compliance Manager performs daily tasks to support the PHP/PIC Compliance Officer with implementation and administration of the PHP Compliance Program. Under the direction of the PHP/PIC Compliance Officer, assists in the monitoring and auditing of PHP practices to ensure ongoing compliance and minimization of risk through the development, review and oversight of policies, procedures, business practices, and guidelines that demonstrate compliance with state and federal laws and regulatory requirements. This position supports the PHP/PIC Compliance Officer in all health plan compliance activities for all product lines. Major duties include, but are not limited to, assisting the PHP/PIC Compliance officer with implementing the elements of an effective health plan compliance program, and facilitating the successful completion of audits by external government agencies. These agencies include but are not limited to, CMS, HSD, DOI, OPM (FEHBP) and DOL (ERISA). The Compliance Manager interacts directly with health plan staff, as well as other PHS staff, regulatory agency staff and external auditors. This position assists in the coordination of responses to regulatory bodies and performs regulatory research and analysis. The Manager also assists with the planning, supervision, and coordination of risk assessments, which includes conducting identified internal monitoring and auditing activities as required for management of PHP's Compliance Program.

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community.

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

• Full Time - Exempt: Yes
• Job is based Rev Hugh Cooper Admin Center
• Work hours: Weekday Schedule Monday-Friday
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.
• Remote: Open to remote applicants in the United States, except for the following states: Wyoming, North Dakota, and Ohio

Ideal Candidate:

Bachelors Degree

Has five to seven years experience in Medicare compliance, healthcare management or law/regulations.  Managed care health plan experience in Medicare, Medicaid or Commercial required.

• Bachelors Degree
• Five to seven years experience in healthcare management or law/regulations
• Managed care health plan experience in Medicare, Medicaid or Commercial required.
• CHC or willing to obtain within 1 year.
  
  
  

Education Essential: Bachelor Degree

 

 

• Assists with ensuring that PHP has written compliance standards and procedures covering all necessary areas to be followed by PHP employees and other agents. Establishes and monitors updates, revisions, training, and communication
• In collaboration with the PHP/PIC Compliance Officer, provides direction and oversight of all compliance program auditing, monitoring and related functions, including Risk Assessments and meeting contractual obligations
• In collaboration with the PHP/PIC Compliance Officer, consults with operational departments and program/ subject matter experts to recommend compliant solutions that support business goals.
• Ability to proactively identify compliance issues and work collaboratively with the PHP/PIC Compliance Officer and operational areas to mitigate risks
• Assists with the implementation and management of compliance training
• Assists with the identification and implementation and conducting monitoring and auditing procedures to determine compliance with PHP standards and procedures
• Provides support for overseeing the prompt and thorough investigation of alleged violations of standards and procedures
• Reports potential fraud and noncompliance to the PHP/PIC Compliance Officer and other accountable internal leadership
• Interacts with operational directors/managers, project managers, senior executives, and line staff regarding compliance and related issues
• Organizes and coordinates cross-functional teams to address compliance issues that involve multiple departments or entities
• Responsible for ensuring all work which includes not limited to audits (internal/external), monitoring, tracking and issues of non-compliance are logged timely and accurately in the Governance Risk Compliance Platform (eGRC).
• All other duties as assigned.

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

Inclusion and Diversity
Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

#NCS123

USD $55.26/Hr.

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.