Cigna Compliance Senior Specialist (Part C)- Medicare Business Support in Birmingham, Alabama
The Compliance Senior Specialist will be responsible for interpretation and dissemination of Medicare rules and requirements in such a way that ensure (i) that all Medicare regulatory requirements and standards are understood, (ii) business processes required to address those regulations and standards are implemented and (iii) any compliance risks are communicated to the Compliance Manager. The Compliance Senior Specialist’s primary area of focus will be pre-service organization determination and overall health services functions. The individual will work closely Cigna-HealthSpring leadership to ensure appropriate development and execution of corrective action plans. This individual must maintain open lines of communication with the business and must promote the enterprise wide culture of compliance.
- Ensure Medicare rules and regulations are communicated timely and in a clear and concise manner to facilitate the business’ understanding of the rule or regulatory change;
- Maintains relationships with partners both internal and external to ensure timely responses to questions regarding internal business processes and contract oversight;
- Collaborate with the business to develop process changes to ensure compliance with rule or regulatory changes;
- Provide subject matter expertise in response to day-to-day business issues;
- Serve as a point of contact for employees to seek clarification on regulations or to report any note compliance issues or irregularities;
- Maintain good working relationships with internal and external parties to ensure open lines of communications and timely responses to compliance questions;
- Support Compliance program oversight by maintaining documentation of compliance issues and ensure updates are documented in a timely manner;
- Assist in the management of Corrective Action Plans (CAPs) for Medicare related issues;
- Support business units by collaboratively facilitating the development of processes and procedures to ensure regulatory compliance, including participation in regular operational team meetings, business process improvement efforts, and compliance improvement initiatives;
- Remains aware of industry changes and/or trends;
- Facilitate the development of processes and procedures to ensure regulatory compliance, including participation in regular operational team meetings, business process improvement efforts, and compliance improvement initiatives;
- Reports on the status of process changes and escalates issues as appropriate;
- Manages relationships with partners both internal and external; performs or assists in coordination of training related program; and
- Remain aware of industry changes and/or trends.
- Bachelor’s degree preferred,
- 5 years’ experience dealing with regulators;
- Strong knowledge of Medicare Advantage regulations required,
- Subject matter expertise in Pre-service Organization Determination guidance and processes required;
- Strong attention to detail and analytic skills required;
- Strong problem solving skills required;
- Strong and confident oral and written communication skills required;
- Ability to work collaboratively with others (and when appropriate influence colleagues in their decision making process) required; and
Certification in Healthcare Compliance (CHC) preferred.
Primary Location: Nashville-Tennessee
Other Locations: United States-Illinois-Chicago, United States-Maryland-Baltimore, United States-Florida-Doral, United States-Alabama-Birmingham, United States-Texas-Houston
Work Locations: 530 Great Circle Road Nashville 37228
Employee Status: Individual Contributor
Job Type: Full-time
Job Level: Day Job
Job Posting: Apr 5, 2018, 3:26:19 PM
Cigna is an equal opportunity employer, which means we offer equal treatment to all applicants. Cigna does not discriminate, either directly or indirectly, on the grounds of race, color, sex, gender identity, sexual orientation, nationality, national origin, ethnic origin, religion, beliefs or creed, age, disability, marital status, veteran status or genetic information in any area of recruitment. In some countries we ask for information on the ethnic origin, gender and disability of our applicants for the purpose of monitoring equal opportunity. If you have a disability and would like to indicate as part of your application any relevant effects of your disability and any adjustment which you consider should reasonably be made to the process to assist your application, please do so in the relevant field during the application process.