Anthem, Inc. Compliance Manager - Medicare Risk Adjustment in Louisville, Kentucky
SHIFT: Day Job
At Empire BlueCross BlueShield, a proud member of the Anthem, Inc. family of companies, serving our communities for over 85 years. We’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve.
Empire’s commitment to inclusion and diversity makes us a stronger organization. Our culture is essential to attracting talent that understands and connects with our consumers. It creates spaces where different perspectives and experiences are valued; it lets us develop innovative thinking and unifies our associates behind our mission—to materially and measurably improve the whole health of all New Yorkers and make healthcare simpler.
Empire’s Whole Health proposition is committed to protecting an individual’s complete health and wellness. Our inclusivity is the foundation to serve and support our diverse New York communities.
Preferred Location: This position will primarily work remotely, but prefer to be located near the Anthem office in Louisville, KY
Compliance Manager – Medicare Risk Adjustment
The Compliance Manager – Medicare Risk will serve as a dedicated compliance manager for our Group Retiree Services (GRS) and related business areas. The Compliance Manager will function as the subject matter expert on Medicare risk adjustment (MRA) concepts and is responsible for managing foundational and strategic compliance responsibilities with consistent excellence that support the team and management. Primary duties for this position may include, but are not limited to:
Manage/oversee projects, initiatives, regulatory audits or exams, internal audits, accreditations, on-site reviews, risk assessments; audit planning, conducting mock audits, conducting audit training, managing audit evidence preparation, assessing audit preparedness.
Establish project plans, gap analysis, milestone dates, and other significant aspects, and leadership updates.
Maintain knowledge of laws, regulations, company strategies to assess impact, and consult with clients as subject matter expert regarding Medicare risk adjustment (MRA) concepts
Conducts complex investigations, document findings, and ensure corrective actions are made.
Interface/lead exchanges with external parties, such as regulators and vendors, as well as internal stakeholders, including, but not limited to, senior leaders
Requires a BA/BS and minimum of 6 years health care, regulatory, ethics, compliance or privacy experience; or any combination of education and experience, which would provide an equivalent background.
Experience analyzing information and drafting memos/reports detailing findings/assessment.
Ability to travel up to 15%
MS/MBA/JD or professional designation preferred.
Excellent writing and communication skills
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact firstname.lastname@example.org for assistance.