This position reports to the Medicare/Medicaid Chief Compliance Officer (MMCCO).
The Head of Medicare Business Support is responsible for leading all the day-to-day compliance initiatives and workstreams that focus on Cigna-HealthSprings Medicare business lines and contracts a critical component of the business units overall Compliance Program.
He or she must be a seasoned professional who knows the Medicare rules and is experienced in contractual and regulatory compliance within the context of the Medicare Program.
The Head of Medicare Business Support is responsible for helping to set an appropriate Tone at the Top of the CHS organization and cultivating a culture that emphasizes integrity; a working atmosphere that promotes open and candid discussions regarding compliance concerns; acceptance of responsibility for actions taken; effective compliance oversight; and operational transparency with key stakeholders, including customers and government clients.
To be successful, this leader must set a collegial tone and operate as a thought partner with CHS business leaders, CHS Compliance colleagues and other in-house professionals, including those in Internal Audit, Legal, Human Resources and Information Security.
The Head of Medicare Business Support must ensure that his/her compliance team understands the operational nuances and realities of the Medicare business, and that pertinent regulatory requirements and developments are communicated in a timely manner to the impacted business partners.
The Director must also provide constructive advice and guidance to facilitate the successful operation of CHS Medicare business.
Other Key Responsibilities:
* Assists the MMCCO in preparing periodic reports to the Global Chief Compliance Officer of Cigna and the Audit Committee of Cignas Board of Directors;
* Develops an effective system for ensuring that relevant legislative, regulatory, enforcement and administrative developments are reviewed promptly, analyzed carefully and communicated to the relevant business leads in a constructive manner;
* At the direction of the MMCCO, serves as one of the Compliance Departments lead representatives with Medicare regulators;
* Identifies policy, regulatory and enforcement trends that might affect the Medicare business, and communicates that advice to the impacted in-house resources;
* Escalates, as warranted, instances of potential non-compliance to the MMCCO;
* Supports the Compliance Director in charge of FDR oversight;
* In cases of possible non-compliance, helps oversee the performance of root cause analyses and assists colleagues in the Corrective Action Plan Monitoring Unit with the development and implementation of any needed corrective action plans;
* Working with the Head of Compliance Communications, ensures that appropriate policies and procedures are adopted and periodically reviewed and, as warranted, revised.
* Provides appropriate support in the bid development and submission process; and
* Provides support in internal and external regulatory and enforcement audits.
* Bachelors degree.
Juris Doctor or masters degree and certificate in healthcare compliance strongly preferred.
* 8+ years experience as a compliance professional in positions of increasing responsibility, with a minimum of five years of experience with the Medicare program.
* Strong preference for experience in the corporate setting and/or in a relevant federal or state agency (e.g., the Centers for Medicare & Medicaid Services).
* Demonstrated experience interacting effectively with federal and state regulators and enforcement agencies.
* A demonstrated commitment to integrity, regulatory compliance and ethical decision making.
* Consistently sound judgment and incisive, three-dimensional analytical abilities.
* Outstanding verbal and written communications skills.
* Demonstrated ability to lead a team effectively in a fast-paced environment.
* Strong, independent decision-making ability leads by example.
* Intellectual flexibility adept at reassessing priorities to ensure that internal and external expectations are fulfilled.
* Demonstrated attention to detail, ability to compile and analyze regulatory and business information, determine cost/benefit, and provide possible resolution strategies or recommendations for process improvement.
* A highly collaborative individual with ability to influence others and build strong professional relationships
* This position requires a customer-focused and creative approach to problem solving and the ability to efficiently manage a substantial number of issues.
* Strong ability to navigate through barriers to drive initiatives throughout the business.
US Candidates Only: Qualified applicants will be considered for employment without regard to race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. If you require a special accommodation, please visit our Careers website or contact us at [Apply online].