Medicare Compliance Lead

Accenture Medicare Compliance Lead - Florham Park, New Jersey

Accenture seeks an individual with a deep understanding and working knowledge of Medicare Advantage (MA) laws, regulations, and Centers for Medicare and Medicaid Services (CMS) guidance to lead Accenture’s Medicare compliance program and initiatives.

The Medicare Compliance Lead will need to:

1. Have a deep working knowledge of the requirements of MA laws, regulations, and CMS guidance.
2. Lead Accenture’s efforts to operationalize MA compliance requirements in Accenture’s business, and implement necessary controls, policies, and procedures.
3. Track and monitor changes in MA laws, regulations, and CMS guidance, manage regulatory tracking software, and work with operational area(s) to perform business impact assessment(s), identify changes to current procedures and work with the Medicare Compliance Officer to implement policies and policy changes needed to maintain compliance with Medicare/regulatory requirements.
4. Monitor CMS regulatory and compliance initiatives relating to Medicare.
5. Serve as Medicare subject matter expert aiding the operational leads/areas with the interpretation and execution of CMS rules, regulations, and/or guidelines. Answer questions from business, compliance, and legal regarding MA requirements.
6. Review, oversee, and monitor client account teams’ implementation of Accenture’s Medicare Operations Compliance Plan (MOCP).
7. Maintain the MOCP and develop, review, implement, and oversee the effective administration of policies and procedures, in partnership with key stakeholders, to facilitate Medicare and regulatory compliance.
8. Perform periodic and “on demand” compliance reviews and audits to identify opportunities and monitor compliance.
9. Assist in responding to client audits where Medicare expertise is needed.
10. Assist in preparing responses to Medicare compliance and offshoring attestations.
11. Assist legal in reviewing and revising Medicare contract flowdown terms.
12. Develop, maintain, and deliver Medicare compliance training programs. Monitor and track compliance with required Medicare training programs.
13. Conduct audits and evaluate internal and downstream entity workflows to assess compliance with Medicare rules, regulations, and guidelines.
14. Compile evidence and documentation that demonstrate Medicare/Regulatory requirements have been met.
15. Proactively identify risks, gaps, and deficiencies and/or business efficiency opportunities through ongoing monitoring activities.
16. Initiate, develop, or support corrective action plans identified through audits or by recommendation of client; follow through on corrective action plans until operational areas meet standards and/or requirements.
17. Monitor key Medicare-related transaction turn-around times to assess operational risk.
18. Evaluate policies and procedures with corresponding desk level procedures to ensure regulatory and CMS requirements are addressed, operational activities compliant, and reporting/success measurement evidence requirements met.

Basic Qualifications:

1. Minimum of 3 years in a managed care organization servicing a Medicare population.
2. Minimum of 3 years working in compliance performing Medicare oversight and training activities including monitoring of CMS regulations and Medicare compliance plan development/maintenance.

Preferred Qualifications:

1. BA/BS.
2. Excellent client and customer service skills, and excellent written and verbal communication skills required.
3. Proven ability to work collaboratively with diverse individuals and situations required.
4. Potential need to travel internationally to the Philippines, India, and/or other international locations.
5. Demonstrated teamwork and collaboration in a professional setting.
6. Medicare Compliance and CMS audit experience.
7. CHC certification preferred.
8. Strong written and verbal communication skills.
9. Strong quantitative, qualitative, and analytical skills or any combination of education and experience, which would provide an equivalent background.
10. Experience using Excel and other data collection or reporting software is preferred.