Medicare Compliance Officer
About Us
Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 138 hospital-based locations, in addition to its home-based services and virtual care offerings.
Our Mission
As CommonSpirit Health, we make the healing presence of God known in our world by improving the health of the people we serve, especially those who are vulnerable, while we advance social justice for all. To learn more about a calling that defines and unites, please click here for more information about our mission, vision, and values.
The posted compensation range of $43.10 - $64.11 /hour is a reasonable estimate that extends from the lowest to the highest pay CommonSpirit in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law.
Job Summary:
The Medicare Compliance Officer (MCO) is responsible for developing, implementing, and overseeing the compliance program for Medicare Advantage (Part C) and Medicare Part D activities for Mercy Care Plan, managed by Aetna, a CVS Company. This role ensures adherence to all applicable federal and state regulations and CMS requirements, safeguarding the integrity and compliance of Plan operations.
Reporting Structure:
This position will maintain day-to-day operational alignment with the Mercy Care Medicare team while holding direct reporting accountability to the Chief Executive Officer (CEO) and the Audit and Compliance Committee of the Mercy Care Plan Board of Directors.
- Provide formal reports to the Board of Directors, CEO, and Compliance Committee at least quarterly, and more frequently as needed, detailing the status of Mercy Care Plan’s Medicare Compliance Program implementation, identification and resolution of compliance issues, and oversight and audit activities.
- Oversee the development and administration of the Board of Directors’ annual Code of Conduct and compliance training program, including program design, content creation, distribution, tracking, and ongoing maintenance to ensure full compliance with regulatory and organizational standards.
- Develop and implement programs and mechanisms that promote a culture of integrity by encouraging managers and employees to report suspected fraud, waste, abuse, or other misconduct, ensuring confidentiality and protection against retaliation.
- Respond promptly to reports of potential Medicare fraud, waste, or abuse, (FWA) including coordinating internal investigations and developing appropriate corrective or disciplinary actions when necessary. Maintain the FWA reporting mechanism and collaborate closely with the Internal Audit Department and the Special Investigations Unit (SIU), as applicable.
- Exercise flexibility in designing and managing internal investigations (e.g., addressing suspected violations or reported issues) and implementing resulting corrective measures, such as policy enhancements and disciplinary actions to ensure compliance and mitigate risk.
- Coordinate with the Plan’s Human Resources department (or equivalent) to ensure thorough screening of the DHHS OIG and GSA exclusion lists for all employees, officers, directors, managers, and contracted entities, including first-tier, downstream, and related entities, confirming none are listed on these exclusions.
Job Requirements
Required
- Bachelors Other or an equivalent combination of directly related workexperience and/or education and
- Five (5) years of experience that demonstrates solid Medicare compliance program development, operation and administration responsibilities
Preferred
- Registered Nurse: AZ
Knowledge Skills and Training:
- Strong Business acumen and healthcare industry
Where You'll Work
Hello humankindness
Located conveniently in the heart of Phoenix, Arizona,St. Joseph's Hospital and Medical Center is a 571-bed, not-for-profit hospital that provides a wide range of health, social and support services. Founded in 1895 by the Sisters of Mercy, St. Joseph's was the first hospital in the Phoenix area. More than 125 years later, St. Joseph's remains dedicated to its mission of caring for the poor and underserved. We are extremely proud to be a nationally recognized center for quality quaternary care, medical education and research. St. Joseph's includes the internationally renowned Barrow Neurological Institute, Norton Thoracic Institute, Cancer Center at St. Joseph's, Ivy Brain Tumor Center, and St. Joseph's Level I Trauma Center (which is verified by the American College of Surgeons). The hospital is also a respected center for high-risk obstetrics, neuro-rehabilitation, orthopedics, and other medical services. St. Joseph’s is considered a sought-after destination hospital for treating the most complex cases from throughout the world. Every day, approximately 20 percent of the hospital’s patients have traveled from outside of Arizona and the United States to seek treatment at St. Joseph’s. U.S News & World Report routinely ranks St. Joseph's among the top hospitals in the United States for neurology and neurosurgery. In addition, St. Joseph's boasts the Creighton University School of Medicine at St. Joseph's, and a strategic alliance with Phoenix Children's Hospital. St. Joseph's is consistently named an outstanding place to work and one of Arizona's healthiest employers. Come grow your career with one of Arizona's Most Admired Companies. Look for us on Facebookand follow us on Twitter. For the health of our community ... we are proud to be a tobacco-free campus.
Depending on the position offered, CommonSpirit Health offers a generous benefit package, including but not limited to medical, prescription drug, dental, vision plans, life insurance, paid time off (full-time benefit eligible team members may receive a minimum of 14 paid time off days, including holidays annually), tuition reimbursement, retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings, as may be amended from time to time. For more information, please visit https://www.commonspirit.careers/benefits.
Unless directed by a Collective Bargaining Agreement, applications for this position will be considered on a rolling basis. CommonSpirit Health cannot anticipate the date by which a successful candidate may be identified.
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Equal Opportunity
CommonSpirit Health™ is an Equal Opportunity/Affirmative Action employer committed to a diverse and inclusive workforce. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, marital status, parental status, ancestry, veteran status, genetic information, or any other characteristic protected by law. For more information about your EEO rights as an applicant, please click here.
CommonSpirit Health™ will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c). External hires must pass a post-offer, pre-employment background check/drug screen. Qualified applicants with an arrest and/or conviction will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, ban the box laws, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances. If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (415) 438-5575 and let us know the nature of your request. We will only respond to messages left that involve a request for a reasonable accommodation in the application process. We will accommodate the needs of any qualified candidate who requests a reasonable accommodation under the Americans with Disabilities Act (ADA). CommonSpirit Health™ participates in E-Verify.