Work a Hybrid Schedule from Oregon, Washington, Idaho or Utah
Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.
Who We Are Looking For:
Every day, Cambia's dedicated team of Director Government Programs Compliance Officer is living our mission to make health care easier and lives better. As a member of the Compliance team, our Director Government Programs Compliance Officer leads the company's Government Programs Compliance efforts, including Medicare Compliance efforts and Federal Employee Program compliance efforts. To develop and oversee compliance with Medicare Part C and Part D contracts, MediGap and FEP, coordinating and implementing compliance activities, and partnering with leadership of the Government Program Division, FEP, Health Care Services Division and Shared Services Division to maintain a high level of compliance. - all in service of creating an economically sustainable health care system.
As a people leader, you are willing to learn and grow, understanding that leadership is a craft that is continuously honed as you support your team and the lives that depend upon us.
Do you thrive as a part of a caring team? Then this role may be the perfect fit.
What You Bring to Cambia:
Qualifications:
Director, Government Programs Compliance Officer would have a J.D. or Master's degree in health care administration, public service administration or related field and seven years work experience in personnel management and compliance related activities, legislative and regulatory activities, health insurance operations or legal research or equivalent combination of education and job-related work experience.
Skills and Attributes:
Demonstrate leadership skills with a proven ability to provide responsive leadership, to delegate, coordinate and motivate staff, to evaluate performance.
Show superb judgment, problem solving, analytical and cognitive, verbal and written communication and presentation skills.
Knowledge of health plan and Medicare legislation and regulations, including government contract benefits policies and practices, rules and regulations for Medicare products.
Demonstrate ability to establish and maintain effective relationships with key external and internal stakeholders.
Ability to coordinate work with other company departments and teams.
Excellent verbal and written communication skills. Ability to communicate effectively, both orally and in writing, with individuals and groups, regarding complex or sensitive issues or regulations.
Knowledge of leadership techniques and approaches to ensure effectiveness in leading a multi-layer organization.
Excellent verbal and written communication skills. Ability to communicate effectively, both orally and in writing, with individuals and groups, regarding complex or sensitive issues or regulations.
Strong experience with Medicare health care products preferred.
Knowledge and experience in Medicare Compliance activities and in working effectively with CMS and key internal stakeholders in identifying, addressing, ameliorating and preventing compliance concerns and problems.
Knowledge of government regulations as they relate to the administration of Medicare health care programs, particularly compliance, and principles and practices of managed care.
Ability in the area of project coordination and management.
Skills in research, writing, public speaking and use of computer.
Knowledge of In-depth health plan operations, philosophy, history procedures, and systems.
Health policy issues related to medical and other health care activities including, but not limited to, health care finance and a broad range of health care public policy issues.
Health insurance, including state, federal and managed care program requirements, with an emphasis on Medicare health care laws and regulations.
Conducts business with high regard for Cambia's corporate values and in compliance with its Code of Business Conduct.
Maintains high regard for member, FEP and Medicare beneficiary privacy and complies with Cambia's Corporate Privacy and information security policies.
Contributes to the achievement of our Corporate Affirmative Action goals and objectives.
Responsible for quality and continuous improvement within the job scope. Contributes to and supports the company's quality initiatives.
Accountable for all actions/responsibilities described in the company's policies and procedures as they relate to this position.
Performs other duties and responsibilities as assigned.
What You Will Do at Cambia:
Directs the development and maintenance of comprehensive Medicare compliance structure within Cambia, and is responsible for providing direction, guidance, guidance, support and oversight for day-to-day Medicare Compliance activities.
Directs activities necessary to assure compliant operation of Medicare Advantage and Medicare Part D contracts as well as MediGap products consistent with federal and Cambia regulatory requirements.
Directs the development and maintenance of the Federal Employee Program (FEP) compliance structure within Cambia, with responsibility for guidance, support and oversight for FEP activities.
Prepares audit findings, corrective action plans and reports to support compliance oversight.
Analyzes new statutes and regulations to determine the operational impact to Medicare and FEP programs and verifying they are implemented properly.
Oversees annual risk assessment and the successful development and implementation of an annual audit plan for the Medicare contracts and FEP products.
In conjunction with the Medicare line of business, oversees marketing and sales activities and materials to support Medicare and sales.
You bring unique value to our community of 200 leaders running our company. By actively engaging with your peers and inspiring your teams, you play an essential role in making health care easier and lives better.
FTEs Supervised
2- 12
Work Environment
Duties are performed primarily in an office environment.
However, travel to Cambia plan sites and other meeting locations is required.
Some out-of-state travel may be required.
The expected hiring range for a Director Government Programs Compliance Officer is $159,800.00 - $216,200.00 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 25%. The current full salary range for this role is $150,000.00 to $245,000.00.
#LI-hybrid
About Cambia
Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.
Why Join the Cambia Team?
At Cambia, you can:
Work alongside diverse teams building cutting-edge solutions to transform health care.
Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
Grow your career with a company committed to helping you succeed.
Give back to your community by participating in Cambia-supported outreach programs.
Connect with colleagues who share similar interests and backgrounds through our employee resource groups.
We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.
In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:
Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
Annual employer contribution to a health savings account.
Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
Award-winning wellness programs that reward you for participation.
Employee Assistance Fund for those in need.
Commute and parking benefits.
Learn more about our benefits.
We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.
