Anthem Regulatory Oversight Mgr 139893 in Victorville, California

/Your Talent. Our Vision./ At Simply Healthcare, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. We are a Florida licensed health maintenance organization that serves individuals enrolled in Medicaid and/or Medicare programs, 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 atone of America's leading health benefits companies and a Fortune Top 50 Company.

TheRegulatory Oversight Manageris responsible for managing, overseeing and contributing to the external audit, monitoring, compliance and risk functions for Medicare.

*Primary duty: * Oversees and leads risk assessment activities including identification, assessment and monitoring of risk.

Other duties may include, but are not limited to: * Leads, coordinates, participates and resolves monitoring and oversight reviews. * Leads, coordinates, participates and resolves audit requests from Center for Medicare and Medicaid Services (CMS), Office of the Inspector General (OIG) or other regulatory authorities to ensure accurate and timely resolution of internal/ external audits. * Leads, coordinates and participates in managing audit planning, conducting mock audits, conducting audit training, managing audit evidence preparation, assessing the quality of audit evidence and audit preparedness. * Participates in the execution of onsite and/or desk audits and collecting anticipated audit findings. * Assists Medicare in responding to audit reports by developing, implementing and monitoring Corrective Action Plans. * Collects and prepares data for required reporting. * Creates and makes presentations on various audit/risk topics to a variety of audiences. * Communicates crucial guidance and information to business owners timely and accurately. * Provides interpretation of guidance to Medicare. * Ensures (accountable) reporting and documentation of the auditing procedures are in place. * Leads and facilitates meetings to ensure the engagement with internal and external stakeholders. * Responds to calls from external and internal stakeholders for guidance and facilitation of audits.

  • Requires BA/BS degree in a related field required, MBA/MA preferred.
  • Experience with overseeing or managing a risk assessment program
  • 5 - 7 years related regulatory or contract compliance experience with the ability to analyze, write and integrate highly technical information into action plans; or any combination of education and experience which would provide an equivalent background.
  • Medicare care experience required.
  • Must be proficient with Excel, Word and PowerPoint.
  • Experience with CMS audits preferred.

/Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran./

Job Fraud

Equal Employment Opportunity Statement Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.

Title: Regulatory Oversight Mgr 139893

Location: california-Victorville

Requisition ID: 139893