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Program Integrity Manager - West Virginia - PS23776Location: United StatesNewRequisition #: PS23776Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which 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 at one of America's leading health benefits companies and a Fortune Top 50 Company.Office Location: 200 Association Drive - STE 200 - Charleston, WV 25311Relocation is not availableSign on Bonus: $5,000 sign on bonusThe Program Integrity Manager will serve as the liaison between the Company and the State Medicaid agency and must be located in the State within a reasonable traveling distance to the State Government Center and the Anthem Office to regularly attend State meetings. Develops project plans and oversees project execution for implementations related to new requirements, issue management and progress reporting. Serves as the primary point of contact/subject matter expert for Program Integrity’s regulatory compliance deliverables, including, but not limited to: Regulatory Requests, Reporting, Audits, RFI’s, Contract Changes, and State Meetings. Works with health plan leaders; oversees the monitoring and enforcement of the fraud, waste, and abuse compliance program for the local state health plan to prevent, detect and report potential fraud, waste, and abuse activities pursuant to state and federal rules and regulations.Primary duties may include, but are not limited to:
Demonstrates extensive knowledge of regulatory and contractual requirements, CMS regulations, and internal data gathering process.
Maintains oversight and ownership of all data gathering related to Health Plan regulatory reports for all Program Integrity functional areas.
Compiles and submits monthly and quarterly reports.
Evaluates regulatory compliance and Health Care Reform changes to determine potential impact.
Works with impacted Program Integrity functional areas to ensure compliance with requirements.
Monitors provisions of the compliance plan, including fraud, waste, and abuse policies and procedures, investigates incidents of non-compliance and implements corrective action plans.
Develops and analyzes monthly reports.
Develops processes to support early detection of systemic issues causing operational inefficiencies or issues of non-compliance.
Requires a BA/BS; 5 years of related work experience, including 2 years of compliance-related experience; or any combination of education and experience, which would provide and equivalent background.
MBA, MPA or MPH preferred.
Program Integrity and fraud, waste and abuse experience highly desired.
Medicaid Compliance experience a plus.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran
Vacancy expired!