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VP Medicare Compliance (PS7131) - Green Bay, WI #5063491

Company: Anthem

Date: 06/13/2018

Category: Insurance

City: Green Bay, WI

VP Medicare Compliance (PS7131)


Location: United States

Field: Executive

Requisition #: PS7131

Post Date: 9 hours ago

Anthem is a Fortune 30 company and a leading health benefit company, with operating revenue of over $85 billion and over $60 billion in assets. Anthem serves over 40 million medical members, or one in every nine Americans. Together we will drive the future of health care . This is an exceptional opportunity to do innovative work that means more to you and those we serve.


This position establishes control points and adherence to all CMS regulations while optimizing Medicare Programs’ professional relationships with CMS Central Office, as well as with each applicable regional office. This position reports to Anthem’s Chief Compliance Officer. Anthem’s Medicare Programs generate several billion dollars in revenue annually and help provide valuable medical coverage to millions of Medicare members. As a federally funded program, the risks of Anthem failing to maintain compliance could result in fines, sanctions and/or termination of Anthem’s MA, Part D and/or Medicare Supplement contracts and licenses. In addition, such fines, sanctions and penalties could impair Anthem’s ability to participate in other federal and state funded programs.

Key to success in this role, the ideal candidate will:

  • Implement the Medicare Compliance Program. The Medicare Compliance Officer is accountable for defining the Medicare Compliance Program structure, educational requirements, reporting, and complaint mechanisms, response and correction procedures, and compliance expectations of all personnel and FDRs supporting Anthem’s Medicare Programs business (including Medicare Advantage, Prescription Drug Program and Medicare Supplement).

  • Ensure Medicare compliance reports are provided regularly (at least quarterly) to theAnthem Board or sub-committee of the Board (i.e., Audit Committee), divisional President overseeing Medicare, and the Medicare Programs Compliance Committee. Reports should include the status of Anthem’s Medicare compliance program implementation/effectiveness, the identification and resolution of suspected, detected or reported instances of noncompliance, and Anthem’s compliance oversight and audit activities; the Medicare Compliance Officer shall have express authority to provide unfiltered reports to Anthem’s Board, sub-committee of the Board (i.e., Audit Committee), Chief Compliance Officer and/or senior leadership.

  • Be accountable for managing and coordinating Anthem’s interactions with CMS. The Medicare Compliance Officer is also responsible for responding to and documenting responses to CMS inquiries

  • Be aware of daily business activity by interacting with the operational units of Anthem and Applicable FDRs

  • Create and coordinate, by appropriate delegation if desired, educational training programs to ensure that applicable Anthem governing body, managers, employees, FDRs, and other individuals working/supporting Medicare program are knowledgeable about Anthem’s compliance program, its written Standards of Conduct, compliance policies and procedures, and all applicable statutory and regulatory requirements

  • Develop and implement methods and programs that encourage managers, employees, and FDRs to report Medicare program noncompliance and potential FWA without fear of retaliation

  • Maintain and/or have access to applicable compliance reporting mechanism and closely coordinating with the internal audit department and the SIU

  • Support and ensure that appropriate support and actions are provided to reports of potential FWA, including the coordination of internal investigations with the SIU or internal audit department and the development of appropriate corrective or disciplinary actions, if necessary. To that end, the Medicare Compliance Officer should have the flexibility to design and coordinate internal investigations.

  • Ensure the DHHS OIG and Government Services Administration (“GSA”) exclusion lists have been checked with respect to all employees, governing body members, and FDRs monthly and coordinating any resulting personnel issues with the sponsor’s Human Resources, Security, Legal or other departments as appropriate

  • Ensure the appropriate documentation is maintained for each report of potential noncompliance or potential FWA received from any source, through any reporting method (e.g., hotline, mail, or in-person)

  • Oversee the development and monitoring of the implementation of corrective action plans

  • Coordinate potential fraud investigations/referrals with the SIU, where applicable, and the appropriate NBI MEDIC. This includes facilitating any documentation or procedural requests that the NBI MEDIC makes of Anthem.

  • Interview or delegate the responsibility to interview Anthem’s employees, FDRs and other relevant individuals regarding compliance issues

  • Review company contracts and other documents pertinent to the Medicare program

  • Review or delegate the responsibility to review the submission of data toCMS to ensure that it is accurate and in compliance with CMS reporting requirements;

  • Maintain a positive relationship with corporate counsel

  • Report potential FWA to CMS, its designee or law enforcement

  • Conduct and/or direct audits and investigations of any FDRs

  • Conduct and/or direct audits of any area or function involved with Anthem’s Medicare Programs (including Part C, Part D and Medsup); and

  • Recommend policy, procedure, and process changes


Communication and Influence

  • Ask tough questions, challenge and engage leaders in conversation to ensure the right things happen for the business

  • Help leaders understand business implications of actions, influencing a change in direction as needed

  • Integrate key messages into all communications to ensure people understand how initiatives work together to support business goals

  • Has the executive presence to influence direction and inspire confidence with Anthem’s senior leaders Visionary Thinking

  • Establish strategies that create or sustain competitive advantage

  • Think broadly and long-term, recognizing the impact of decisions and actions on Anthem’s membership, business and key stakeholders over time Focus your people

  • Create an environment that enables and focuses people on the company’s mission and vision

  • Inspire superior performance by cultivating ownership and personal commitment to goals and objectives

  • Communicate strategic context to ensure people understand what we are doing and what drives them

  • Discontinue efforts not focused on critical business priorities Executing for Results

  • Hold oneself to the highest standards of accountability; has the ability to drive change while maintaining operating effectiveness; integrates and aligns efforts across functions; monitors results; tackles problems directly and delegates effectively. Direct Reports:8 indirect reports: 70


  • Bachelor's degree in a related field (Master's preferred)

  • Minimum of 10-15+ years of experience in large, corporate healthcare

  • Demonstrated experience managing an enterprise-wide relationship with CMS

  • Minimum of 8 years of experience managing a compliance operation in a Medicare environment

  • Demonstrated successful leadership skillsin program management, program execution, and people management

  • Strong analytic skill set to identify and prioritize strategies and initiatives for growth

  • Ability to plan,organize, administer, and coordinate a varietyof large and complex services, projects, and programs

  • Successful leadership and management experience building effective teams, managing cross functional teams, and continuous improvement/staff development programs

  • Demonstrated superior oral/written interpersonal communication, persuasion, and negotiation skills

  • Strategic thinking and demonstrated organizational leadership capabilities required

  • Innovation and creativity, teamwork and communications

  • Ability to successfully interface at all levels with the customer, industry, and corporate entities

*Position located in one of Anthem’s nationwide offices, with expected heavy nationwide travel. This position may be considered as work from home.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran.

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