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Manager, Qualiity, Compliance & FWA

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Benecard Services IncBonita Springs, FL
  • JOB SUMMARY: Under the direction of the Senior Director, the Manager, Quality, Compliance and FWA is responsible for ensuring the Benecard Companies meet and maintain ongoing compliance with all applicable Medicare and other federal and state regulatory requirements.
  • The Manager is responsible for the monitoring and oversight of all compliance and regulatory requirements.
  • ESSENTIAL DUTIES AND RESPONSIBILITIES:Interpret and disseminate information on regulatory matters.
  • Develop, review and modify compliance information in manuals, forms and/or contracts, as needed.
  • Responsible for the execution of an enterprise-wide sampling and monitoring plan including communicating CMS or other rules and regulations.
  • Review and oversee corrective action plans, as necessary.
  • Support a comprehensive Fraud, Waste and Abuse program that adheres to federal or state requirements.
  • Responsible for ongoing activities to detect, correct, report and prevent Fraud, Waste and Abuse in all areas of the companyOversight of the activities of delegated entities.
  • Accept issues from internal customers, understand the underlying root cause, review regulatory rules, conduct analysis of risks and make recommendations to the operational departments to ensure compliance with requirements.
  • Develop and annually review compliance policies and procedures to ensure consistency with governing statutes, regulations and other guidance.
  • Review and update policies as laws and regulations change.
  • Provide written and oral advice and guidance regarding compliance requirements that impact the company's products and business.
  • Act as an internal resource on matters related to vision and pharmacy rules.
  • Support overall enterprise-wide compliance and risk management strategy.
  • Maintain a comprehensive understanding of all new and existing regulatory requirements that impact vision and pharmacy operations.
  • Assist with the development and implementation of the annual auditing and monitoring work plans.
  • Identify regulatory metrics to track compliance.
  • Develop and maintain robust auditing and monitoring tools and standardized forms.
  • Assist in and make recommendations for identification of compliance and quality indicators and benchmarks.
  • Identify areas of potential compliance risk and collaborate with management to develop solutions for risk mitigation.
  • Participate in CMS, state or health plan related audits and reviews.
  • Develop and provide training and education programs for the organization.
  • Assist in the development of a variety of training tools and communication vehicles to reinforce compliance enterprise-wide.
  • Deliver training presentations and workshops as required or necessary.
  • Manage projects as assigned, including product development and national compliance initiatives.
  • Coordinate compliance information for presentation to the Compliance Committee, Board Compliance Committee or the Board of Directors, as necessary.
  • Perform other duties, as assigned.
  • INTERNAL/EXTERNAL RELATIONSHIPS: Interaction with all levels of the organization and certain external vendors.
  • SUPERVISORY RESPONSIBILITIES: YesQUALIFICATION REQUIREMENTS: To be successful, an individual must be able to perform each essential duty and responsibility satisfactorily.
  • The requirements listed below are representative of the knowledge, skill and/or ability preferred.
  • Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • Education and/or Experience:BA/BSMinimum of 3 years' experience with Government programs a mustPrior experience in the vision, pharmaceutical, healthcare or managed care industryKnowledge of vision and/or pharmacy benefit programsExperience in Healthcare Compliance, Quality Improvement, and Regulatory Compliance, including training, policy management, investigations, auditing and corrective action plans.
  • Previous management experience working effectively with multi-functional areas.
  • Other Skills and Abilities:Ethical conduct.
  • SharePoint skills a plus.
  • High degree of professionalismTravel Requirements:Minimum travel requiredWork Environment:ProfessionalOffice settingWe are an equal opportunity employer.

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