Lead Director, Compliance (Medicare)
CVS Pharmacy - Harrisburg, PA
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Job DescriptionAs the Lead Director, Compliance you will be responsible for leading CMS audits, supporting State and Financial (1/3) audits, administering the PCAT tool, and performing oversight on internal risk adjustment processesYou will be responsible for leading CMS audits, supporting State and Financial (1/3) audits, administering the PCAT tool, and performing oversight on internal risk adjustment processes. Fundamental Components Lead entire organization operational teams for CMS audits of Aetna/CVS, interacting directly with CMS regulatory personnel Drive implementation CMS audit protocol changes Project manage State audits for DSNP and Medicare-Medicaid Plans, CMS financial audits, and other regulatory audits Facilitate corrective action plans for regulatory audits Administer key components of Medicare risk adjustment including oversight of provider coding results Conduct oversight of risk adjustment operational areas related to Commercial and Medicare risk adjustment, oversight of internal QA processes for vendors, and other risk adjustment areas Facilitate the Regulatory & Governance MRA workgroup providing oversight for Medicare Risk AdjustmentRequired Qualifications Past Medicare CMS Program Audit experience is a must have. Medicare general compliance and operational oversight experience Previous leadership and development of a team experienceCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualificationsn/aEducationBachelor's degree or equivalent work experience.Business OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
Created: 2024-09-07