Providence Compliance Medicare Consultant in Beaverton, Oregon
Providence St. Joseph Health is calling a Compliance Medicare Consultant to our location in Beaverton, OR.
We are seeking a Compliance Medicare Consultant to have regional responsibilities related to Oregon and Washington and other emerging markets. It manages and leads various enterprise-wide Medicare compliance-related initiatives and projects. The project work is multi-faceted requiring complex regulatory analysis and interpretation, the leading of multi-departmental work teams, preparation and response to CMS audits, preparation of Medicare expansion applications, and managing multiple and ever changing CMS deadlines. The position serves as an internal consultant and subject matter expert to leadership and staff regarding regulatory obligations as well as Medicare-specific contracts, benefits, and policies. The work of this position impacts PHA's legal and regulatory and financial obligations to CMS as well as our obligations to our Medicare members. Non-compliance can result in legal action, financial sanctions and/or financial recoveries.
In this position you will have the following responsibilities:
Functions as liaison between PHA and federal regulatory staff regarding filings and regulatory requirements.
Analyzes, interprets and communicates regulatory interpretations to leadership and staff at PHA.
Provides guidance and expertise to benefit design and product implementation teams at PHA.
Project manager for various Medicare Advantage activities/initiatives including geographic expansion applications, member contract/materials process, CMS audit preparation, compliance program implementation, etc.
Consults with internal and external resources including legal counsel as needed to fulfill these duties.
Provides orientation, training, and support to leadership and staff at PHA regarding regulatory compliance and contract requirements for Medicare products.
Required qualifications for this position include:
Bachelor's Degree or Associate Degree and 4 years in a related field.
5 years relevant health plan, compliance and/or legal experience or experience in another regulated industry.
5 years experience with two of the following: Process improvement, policy and procedure development, technical or legal writing, written customer communications.
For information on our comprehensive range of benefits, visit:
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Compliance
Req ID: 274867