Director, Medicaid Compliance - Hybrid

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.AZ Blue offersa variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week

• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week

• Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month

• Onsite: daily onsite requirement based on the essential functions of the job

• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

PURPOSE OF THE JOB

The Director of Medicaid Compliance is responsible for the oversight, administration, and implementation of the Medicaid compliance and accreditation programs. This position reports directly to the General Manager of the Medicaid Segment at BCBSAZ. The Director of Medicaid Compliance shall hold the Corporate Compliance Officer Key Staff Position required by AHCCCS. This position has the authority and responsibility to make independent referrals to the AHCCCS Office of Inspector General or Program Integrity or other duly authorized enforcement agencies relating to reports of fraud and abuse or other non-compliance. This position is responsible for monitoring overall compliance with all deliverables related to the AHCCCS contract and accreditation.

REQUIRED QUALIFICATIONS

1. Required Work Experience

* 8 years or more of corporate compliance, legal or related field of experience is required

* 8 or more years working in a managed care environment

* 3 to 5 years of supervisory experience

2. Required Education

* Bachelor's in Public Administration, Business Administration, Law, Health Care, Behavioral Health or a related field

3. Required Licenses

* N/A

4. Required Certifications

* N/A

PREFERRED QUALIFICATIONS

1. Preferred Work Experience

* N/A

2. Preferred Education

* Master's in Public Administration, Business Administration, Law, Health Care, Behavioral Health or a related field

3. Preferred Licenses

* N/A

4. Preferred Certifications

* N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

• Leads with integrity and confidence, with a strong ability to appropriately identify and communicate risks including but not limited to compliance deliverables, regulatory audits, and accreditation progress.
• Solutions oriented mindset with the ability to effectively and collaboratively manage issues to full resolution.
• Develops, implements and oversees the Medicaid compliance and accreditation programs; develops an annual compliance and accreditation auditing and monitoring plan in coordination with internal departments; annually evaluates the effectiveness of the plan for internal control assessments. Develops and monitors compliance policies in accordance with federal and state laws and contract requirements.
• Provides oversight and coordination of compliance planning, auditing and risk assessment activities. Provides prompt response to compliance issues as they are raised, investigation of potential compliance problems as identified during self-evaluation and audits, correction of such problems promptly and thoroughly to reduce the potential for recurrence, ongoing compliance with requirements under the AHCCCS contract, and external monitoring and auditing of subcontractors.
• Reviews all necessary information and makes referrals to the state and/or federal Program Integrity offices of non-compliance, as appropriate; tracks and trends all fraud and abuse complaints timely and appropriately based on regulations and internal corporation standards and leads the work of the Medicaid Segment Program Integrity reviewers.
• Monitors compliance with contract rules and regulations pertaining to the organization.
• Serves as the primary liaison with the AHCCCS compliance officers.
• Provides and plans annual compliance training to all staff in the organization related to the detection and reporting of fraud and abuse, Federal False Claims Act, any State laws relating to civil or criminal liability or penalties for false claims and statements, whistleblower protections under such laws, including but not limited to fraud and abuse awareness campaigns. Coordinates with all departments, senior leadership, and Board of Directors about compliance matters. Chairs the Compliance Committee and may participate on other committees to ensure compliance within the organization. Reviews and approves health home compliance programs on an annual basis.
• Is located on-site and is available to all staff, with designated and recognized authority to access provider records and make independent referrals to the State Licensing and Contracting agencies including the Office of Inspector General or other duly authorized enforcement agencies.
• Leads the charge in focus and implementation of the organization's culture and strategic plan in a way that aligns to the mission, vision, and values of the organization. Performs other position appropriate duties as required in a competent, professional, and courteous manner.
• Perform all other duties as assigned.
• The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.

COMPETENCIES

REQUIRED COMPETENCIES

1. Required Job Skills

* Strong analytic skills with the ability to draw conclusions and translate complicated data into useable information that can be clearly communicated.

* High tolerance for complex, ambiguous, and shifting environments, including a matrix management structure.

* Work within strict deadlines

* Ability to communicate clearly with employees at all organizational levels, and across differing cultural backgrounds

* Current and applied knowledge of the HIPAA regulation

* Excellent Excel skills, accounting software packages and/or spreadsheets

2. Required Professional Competencies * Current and applied knowledge of the HIPAA regulation * Excellent Excel skills, accounting software packages and/or spreadsheets

3. Required Leadership Experience and Competencies

* Ability to manage, lead, and motivate people

PREFERRED COMPETENCIES

1. Preferred Job Skills

* Experience with project management helpful

2. Preferred Professional Competencies

* N/A

3. Preferred Leadership Experience and Competencies

* N/A

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.