This role will act as CHRISTUS Health Plan's Medicare Compliance Officer. This full time leadership position will contribute to the organization's mission and vision by planning, designing, implementing and maintaining of a Health Plan compliance program designed to comply with CHRISTUS Health's Code of Ethics and all applicable state and federal laws and regulations. This position requires an in-depth understanding of the legal and regulatory environment affecting health plans and is accountable for the oversight of all health plan compliance program efforts, including the Special Investigative Unit (SIU).
This position manages the interface with the Centers for Medicare and Medicaid Services (CMS), and all other federal and state regulatory agencies that provide health plan oversight. This position oversees the implementation of new and revised program requirements and is responsible for the ongoing maintenance of compliance activities. This position must be familiar with the CHRISTUS Health business, ethics and operational practices.
The Health Plan Compliance program includes the implementation and maintenance of proper preventive, detective and remedial programs and controls; the execution of relevant policies and procedures; training and educating the workforce; implementing an effective communications program; ensuring effective testing, auditing, monitoring, tracking and reporting; and remediating control deficiencies. The Health Plan Compliance program encompasses many subject matter areas, including all applicable, state Medicaid, CMS Medicare regulations, DoD TRICARE (US Family Health Plan), Health Insurance Exchange, compliance training, Medicare-related compliance investigations, Medicare-related fraud, waste and abuse, exclusion lists, and third-party compliance oversight, among others.