Regulatory Compliance Manager PS4894

Regulatory Compliance Manager PS4894
Location: United States
Field: Fraud
Requisition #: PS4894
Post Date: Apr 17, 2018
_Your Talent. Our Vision._ At Anthem, Inc., it?s a powerful combination, and the foundation upon which we?re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care .
This is an exceptional opportunity to do innovative work that means more to you and those we serve atone of America's leading health benefits companies and a Fortune Top 50 Company.
Location: Any Anthem office or Telecommute.
The Regulatory Compliance Manager is the audit lead for Anthem's First Tier, Downstream and related entities (FDR)?ensuring compliance with CMS requirements. Responsible for managing external audits and ultimate compliance of the delegated entities performing services on behalf of Anthem Medicare business.
Primary duties may include, but are not limited to:
+ Leads, coordinates and participates in managing audit planning, conducting audits, conducting audit training, managing audit evidence preparation, assessing the quality of audit evidence and audit preparedness. Participating in the execution of onsite and/or desk audits and collecting anticipated audit findings.
+ Assists Medicare Business in responding to audit reports by developing, implementing and monitoring Corrective Action Plans. Accountable for the reporting and documentation of the auditing procedures that are in place.
+ Leads, coordinates, participates and resolves audit requests from Center for Medicare and Medicaid Services (CMS), Office of the Inspector General (OIG) or other regulatory authorities to ensure accurate and timely resolution of internal/external audits
+ Leads and facilitates meetings to ensure the engagement with internal and external stakeholders.
+ Responds to calls from external and internal stakeholders for guidance and facilitation of audits and audit requirements.
+ May also assist with Joint Venture, Pharmacy Benefit Management (PBM) and Fraud Waste and Abuse (FWA) activities associated with Medicare Business.
Requires BA/BS degree in a related field, 5 - 7 years related regulatory or contract compliance with ability to analyze, write and integrate highly technical information into action plans; or any combination of education and experience which would provide an equivalent background. Medicare Managed care experience required. Part D and/or audit experience strongly preferred.
_Anthem, Inc. is ranked as one of America?s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran._

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