Title: Medicare Operations Compliance Officer

Medicare Operations Compliance Officer • 534611 • PHOENIX • REMOTE OPTIONS • AHCCCS • Full-time AHCCCSArizona Health Care Cost Containment System Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork The Arizona Health Care Cost Containment System (AHCCCS), Arizonas Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards for excellence in workplace effectiveness and flexibility. AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry. Come join our dynamic and dedicated team. Medicare Operations Compliance Officer Division of Managed Care (DMC)Job Location: Address: 150 North 18th Avenue Phoenix, Arizona 85007All AHCCCS Employees must reside within the state of Arizona. Posting Details: Salary: $82,000 - $86,000 Grade: 23FLSA Status: ExemptPosition will remain open until filled. Job Summary: This position is a specialized Operations Compliance Officer (OCO) on the Arizona Long Term Care System (ALTCS) team within the Division of Managed Care. The position is responsible for having a comprehensive understanding of federal and state regulation regarding Medicare, Medicaid, and service to dually-eligible individuals. In addition, this position provides Medicare expertise inside and outside the agency and is responsible for advancing the health care system as it relates to Special Needs Plans, Medicare/Medicaid alignment, service coordination, and related monitoring/oversight. This position will continually look for system improvements and efficiencies to improve the lives of the members as well as promote better health outcomes and reduced costs. This position will work independently and advise agency leadership on key considerations/issues specific to Medicare and impact to the Medicaid program/members served as well as provide education to any AHCCCS staff who need to understand Medicare/Medicaid implications. This position will be the single point of contact regarding Medicare questions and will serve as the key contact for the MCOs as well as Medicare plans that do not hold current contracts with AHCCCS. Additional duties include but not be limited to: • Identifying areas of improvement and opportunities for getting more members aligned and care integrated. • Tracking aligned AHCCCS members and monitoring for trends/risks associated with alignment efforts. • Creating and maintaining a Benefit Summary for Medicare Plans which outlines AHCCCS benefits and co-pays. • Providing or assisting with required certification to Medicare Advantage plans that are applying to CMS. • Interfacing with the Centers for Medicaid and Medicare Services (CMS) Office, the CMS Medicare-Medicaid Coordination Office (CMCO), and any consultants studying the AHCCCS integrated care model. • Planning, organizing, and directing the functions related to the dual eligible integration initiatives. • Writing the necessary policies and contract changes that are needed for the implementation of the initiatives. • Identifying and prioritizing dual eligible projects and monitoring the actual implementation of dual eligible integration initiatives. • Leading and/or participating in work-groups, work assignments, etc. that have implications to dually-enrolled individuals, even if the work itself is not primarily focused on Medicare considerations. • Travel, work group, conference participation, and public presentations related to Arizona's efforts with dually eligible members in Arizona. Job Duties: Major duties and responsibilities include but are not limited to: • Serve as an in-house expert on Medicare law and regulations pertaining to Medicare Advantage Plans will focus on the Special Needs Plans serving the duals eligible for both Medicare and Medicaid, providing subject matter expertise to inform policy/program development and/or monitoring and oversight initiatives. • Ongoing oversight of MCOs, including review of deliverables to monitor compliance. Review work completed by the agencys EQRO related to Medicare/dually eligible service delivery. Develop independent audits or related activities as needs are identified. Work with other units to review materials/offer education/support. • Plan, organize, implement, and direct the functions related to service of dually eligible individuals and related integration initiatives. Develop and/or monitor data to identify trends, risks, and/or opportunities. • Revise and/or develop and write policies and/or contract language as well as interpret various administrative rules, regulations, policies and procedures. • Represent AHCCCS at meetings with MCOs, other state agencies/programs, and other relevant stakeholders. Participate in special projects related to Medicaid managed care, including rules teams, fraud prevention, contract development, MCO procurement as needed. • Provide technical assistance to MCOs, providers, members and other internal and external customers. • Meet with CMS/CMCS on a monthly basis and provide updates on Arizona-specific efforts, seek technical assistance as needed, and evaluate future needs for Arizona-specific Medicare/Medicaid requirements. Implement federal guidance related to Medicare across the agency. Support relevant CMS and/or HHS OIG audits/requests for information and work with agency staff to coordinate responses. • Create and maintain reports Including a Benefit summary for Medicare Plans, which outlines AHCCCS benefits and co-pays and providing or assisting with required financial certification to Medicare Advantage plans that are applying to CMS. Knowledge, Skills & Abilities (KSAs): Knowledge: • Principles and practices of healthcare delivery systems • Medicare laws and regulations pertaining to Medicare Advantage Plans with focus on the Special Needs Plans serving dually eligible members • Principles and practices of managed healthcare • Long Term Care populations and unique considerations for care coordination/service delivery • State and Federal laws, statutes and administrative rule pertaining to Medicare and Medicaid • AHCCCS policies and procedures • Principles and practices of effective administration/ oversight with particular attention to planning, implementing, and evaluating programs/projects • Principles of program and policy research • Principles and practices of project management Skills: • Organizational skills that result in multiple tasks. • Analysis, evaluation, and resolution of complex issues • Excellent interpersonal skills both one-on-one and in large groups • Presentation development and public speaking • Effective collaboration with people in positions on all levels and/or varying backgrounds • Effective project management to meet goals and deadlines • Use of computer skills (e.g., word processing, spreadsheets, databases) • Navigating complex rules and regulations to ascertain compliance/adherence to requirements Abilities: • Effectively lead and/or facilitate a team of professionals of varying backgrounds from within and/or outside the agency • Produce clear and effective written communication • Multi-task In a fast paced environment • Produce work products with limited supervision • Develop/write effective policy documents • Describe complex regulations/priorities at a lay person level to ensure understanding Qualifications: Arizona Driver's License. Minimum: • 3 years of experience in Medicare and/or working with dually-eligible populations. Preferred: • Bachelor's degree in Public Administration, Public Health, Business Administration, Communication, or related field and 5+ years experience in Medicare, healthcare, public health, Medicaid, non-profit strategic planning, or project management. • Project Management Certification preferred. Pre-Employment Requirements: • Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agencys ability to reasonably accommodate any restrictions. • Travel may be required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12.) If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Drivers License Requirements. All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify). Benefits: Among the many benefits of a career with the State of Arizona, there are: • 10 paid holidays per year • Paid Vacation and Sick time off (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees) • Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child. Learn more about the Paid Parental Leave pilot program here. • Other Leaves - Bereavement, civic duty, and military. • A top-ranked retirement program with lifetime pension benefits • A robust and affordable insurance plan, including medical, dental, life, and disability insurance • Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications) • RideShare and Public Transit Subsidy • A variety of learning and career development opportunities By providing the option of a full-time or part-time remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion. Learn more about the Paid Parental Leave pilot program here. For a complete list of benefits provided by The State of Arizona, please visit our benefits page Retirement: Lifetime Pension Benefit Program • Administered through the Arizona State Retirement System (ASRS) • Defined benefit plan that provides for life-long income upon retirement. • Required participation for Long-Term Disability (LTD) and ASRS Retirement plan. • Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period). Deferred Retirement Compensation Program • Voluntary participation. • Program administered through Nationwide. • Tax-deferred retirement investments through payroll deductions. Contact Us: Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing careers@azahcccs.gov . Requests should be made as early as possible to allow time to arrange the accommodation. The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer. Remote About the Company: Arizona Health Care Cost Containment System (AHCCCS) Apply tot his job