Compliance Officer - Brooklyn, NY

Brooklyn NY 11201

Job Description

Responsible for the development, implementation, oversight and administration of business unit specific compliance program(s). This position also serves as the primary contact for compliance communications for Magellan. The Compliance Officer is responsible for ensuring overall compliance with all pharmacy-related activities and programs. Promotes an awareness and understanding of positive ethical and moral principles consistent with the mission, commitment, and core values of the organization and those required by federal and state law.
  • Develops, implements and oversees business unit compliance program
  • Serves as the primary compliance contact and is responsible for ensuring overall compliance with compliance requirements
  • Coordinates implementation of system-wide programs, policies, and procedures to ensure system compliance with applicable federal and state laws and regulations
  • Responsible for organizational compliance with transmittals, HPMS notices, required applications and submissions.   Maintains HPMS information, as appropriate
  • Implements, and maintains a system for confidential reporting and investigation of compliance concerns with an appropriate response process. 
  • Builds a risk-based compliance monitoring program, including a system for identification of compliance issues as well as tracking, remediation and documentation of such issues
  • Coordinates with legal counsel in response to identified compliance questions, concerns, or federal/state inquires or investigations.
  • Directs efforts to communicate compliance programs, including written materials and training programs designed specifically to promote understanding of compliance issues, laws and regulations, and consequences of non-compliance
  • In coordination with legal counsel, maintains awareness of laws and regulations, keeping abreast of current changes that may affect health care systems. 
  • Reviews reported issues, concerns, or questions relative to compliance matters.  Provides consultative leadership and support to all entities as appropriate.  Includes close coordination with all levels of management throughout the Company
  • Develops, implements, oversees a monitoring program to monitor internal processes and external entities for compliance with applicable laws, regulations and program guidance
  • Produces and analyzes routine and ad hoc operational monitoring reports; provides regulatory and operational subject matter expertise, for analysis of policy and interpretation, testing monitoring and adherence to requirements
  • Supports the development of regulatory and operational business requirements for ?best practice? implementation of applicable state and federal laws and CMS rules and regulations
  • Coordinates the development, implementation, and maintenance of audit controls and measurements for internal and external processes; ensuring correct processes are in place for accurate, complete, and compliant programs across the system including First Tier, Downstream and Related entities (FDRs). 
  • Works cross-functionally to ensure identified non-compliance is remediated
  • Communicates to and works collaboratively with the Chief Executive Officer, the Board of Directors, the Corporate Compliance Officer and in-house Legal counsel. 
  • Prepares monthly and/or quarterly compliance summaries for the organizations leadership, as outlined above, as well as the Compliance Committee
  • Ensures that disciplinary action is conducted in an appropriate and uniform manner.
  • Provides guidance as needed on Magellan's Medicare Advantage First Tier Entity Compliance Programs.

General Job Information

Title

Compliance Officer - Brooklyn, NY

Grade

30

Job Family

Legal Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

4/22/2019

Date Requisition Created

4/22/2019

Minimum Qualifications

Education

Bachelors (Required)

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • Healthcare software and word processing experience.
  • Extensive knowledge of reimbursement systems; federal, state, and payer-specific regulations.
  • Strong leadership, interpersonal, and problem solving skills.
  • Excellent written and verbal communication skills.
  • Proven ability to effectively represent company and program interests to government regulators.
  • Demonstrates personal traits of a high level of integrity, team orientation, professionalism, and trustworthiness.
  • Places a high value on ethical standards and treating others with dignity and respect.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

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