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Description SHIFT: Day JobSCHEDULE: Full-timeYour Talent. Our Vision. At Simply Healthcare, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. We are a Florida licensed health maintenance organization that serves individuals enrolled in Medicaid and/or Medicare programs, 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. Medicare Clinical Quality / Compliance Admin - Tampa, FL or Miami, FL - PS39429Work Location: This position will work from either our Tampa, FL or Miami, FL office location. This position is responsible for coordinating and conducting internal Medicare audits and activities related to Medicare compliance at the health plan.Primary duties may include, but are not limited to:Develops and maintains pertinent CMS Medicare compliance plans.
Monitors adherence to plans and prepares status reports.
Conducts audits, identifies training and communication needs, and implements related programs as pertaining to Medicare audit and remediation.
Ensures all policies and procedures are updated as legislation or CMS/Medicare standards change.
Implements standardization of procedures and documentation within operations departments and health plan.
Develops and delivers executive level presentations and represents senior management on compliance issues and related committees.
Qualifications Requires a BA/BS
3 or more years of compliance, audit or quality improvement experience; or any combination of education and experience, which would provide an equivalent background.
Experience with regulatory/accreditation or CMS audits and knowledge of regulatory/accreditation standards in a health or managed care environment is preferred.
Ability to travel overnight may be required.
Strong organizational skills and project management skills.
Experience in Medicare Operations strongly preferred.
Ability to work from our Tampa or Miami, FL office location required.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.REQNUMBER: PS39429
