Senior Medicare Compliance Consultant

$36.41 - $60.69 / hour, based on education & experience

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In accordance with State Pay Transparency Rules.

You have a place in the health care industry. At Banner Health, caring for people is at the core of all we do. We are committed to diversity, equity, and inclusion.

If that sounds like something you want to be a part of - apply today!

The schedule for this role is 5 / 8’s, 8 : 00 AM 5 : 00 PM (AZ Time). In this position, you will be monitoring Medicare Advantage Parts C & D operational control measures ensuring appropriate oversight is in place for accurate, complete, and compliant activities.

This team highly values experience with :

• Monitoring internal operational control measures ensuring appropriate oversight is in place for accurate, complete, and compliant for Medicare Advantage Parts C & D.
• Identifying and documenting all noncompliance related activities and reports accordingly in a timely fashion.
• Working in a start-up environment.
• Medicare Advantage Compliance training, audits, regulations, and manuals.
• Reviewing Policy and Procedures.
• Ensuring reporting requirements are maintained in a timely and accurate fashion, including the resolution of each case / issue identified and closed.
• Participating in the preparation of presentation materials designed specifically to communicate and promote the understanding of compliance.
• Overseeing the thorough documentation of all compliance and noncompliance related activities.

This is a fully remote position and available if you live in the following states only : AK, AR, AZ, CA, CO, FL, GA, IA, ID, IN, KS, KY, MI, MN, MO, MS, NC, ND, NE, NM, NV, NY, OH, OK, OR, PA, SC, TN, TX, UT, VA, WV, WA, WI & WY.

POSITION SUMMARY

This position coordinates Banner’s Compliance Program and its related policies, procedures, processes, and activities. Based on the area of assigned responsibility, assists in actively managing compliance-related matters by region, business area, or facility.

Such matters include assisting compliance personnel throughout Banner, helping develop and distribute compliance documents, providing compliance training and education, conducting compliance investigations and reports, monitoring and auditing activities, responding to allegations of improper or illegal activities, and investigating and remediating identified systemic problems.

CORE FUNCTIONS

• Manages highly complex and sensitive questions, concerns, and complaints related to compliance matters, providing answers and support to system, divisional, regional, and facility leadership.
• In consultation with others in the Compliance and Legal Departments, manages Banner’s response to governmental or other third-party audits, investigations, or inquiries.
• Supports the system, division, regional, or facility compliance management staff by responding to questions or concerns, researching matters of note, providing training as necessary and developing processes and procedures to remediate concerns or issues.
• Stays knowledgeable on current compliance-related laws and regulations through personal initiative, seminars, training programs, and peer contact.
• This position interacts with a multitude of executive and senior management, physicians, and staff throughout Banner depending on the facility, division, or area that is being reviewed or assisted.

MINIMUM QUALIFICATIONS

• Must possess a strong knowledge of business and / or health care compliance as normally obtained through the completion of a bachelor’s degree in business administration, accounting / finance, or health care related field.
• Must also possess five plus years of current and progressive experience in healthcare compliance or an equivalent combination of relevant education and experience.
• Requires knowledge of laws and regulations pertaining to health care, regulatory compliance, Medicare / Medicaid, and / or financial reimbursement systems.
• Must possess strong planning skills and problem-solving skills.
• Must possess strong oral and written communication skills to effectively interact with senior management team, physicians, and federal and state governing bodies.
• Must also possess highly effective negotiation skills to communicate and interact with senior management team and physicians.

PREFERRED QUALIFICATIONS

• Master's degree and / or professional designations preferred.
• Previous payer, health care or academic compliance experience preferred as relevant.
• Additional related education and / or experience preferred.

Anticipated Closing Window (actual close date may be sooner) : 2025-02-01

EEO Statement : EEO / Female / Minority / Disability / Veterans (https : / / www.bannerhealth.com / careers / eeo)

Our organization supports a drug-free work environment.

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