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Medicaid Compliance Officer (Director) - Delaware

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Job Details
Job Order Number
Company Name
Highmark Health
Physical Address

Wilmington, DE 19806
Job Description

Company :

Highmark Inc

Job Description :


This job oversees the Government Compliance Medicaid Team. Government Compliance is responsible for the implementation of the Medicaid Compliance program. The incumbent ensures the business is properly following the growing number of laws, regulations and other requirements set for by the government (both State and Federal). Must be able to lead the development, implementation, and maintenance of an effective government compliance and risk management program in multiple states. Acts as a trusted business partner providing compliance advice and guidance. Oversees definition of program structure, reporting and compliance mechanisms, response and correction procedures, and complaint expectations for all personnel that support the core functions of the Medicaid program.


+ Perform management responsibilities including, but not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.

+ Oversee the Medicaid Government Compliance team and for the implementation of the MedicaidCompliance program. This leadership role makes sure the business is properly following the growing number of laws, regulations and other requirements set forth by the government (both State and Federal).Must be able to lead the further development, implementation, and maintenance of an effective government compliance and risk management program.

+ Direct business owners and management across the organization on all aspects of regulatory requirements. Specifically subject matter expert in knowledge and comprehension of requirements, organizational support related to understanding of requirements, coordinate ongoing monitoring of any new applicable requirements, manage centralized reporting of new requirements, and oversee remediation of any identified risks related to regulatory requirements.

+ Manage complex regulatory projectsto monitor ongoing compliance with existing requirements, as well as addressing any changes, corrections, clarifications, or new requirements, by:developing and implementing work plans, obtaining status updates, reviewing outcomes, recommending changes (as needed), and working with the applicable business owner on finalization.

+ Report to the Board of Directors and other Board-level/ownership level organizations on the activities of the Medicaid Government Compliance team, preparing routine and ad-hoc reports on departmental activities, investigations, audits, and risk assessments.In role of Medicaid Compliance Officer, routinely interface with external State and Federal agencies.

+ Lead all State and Federal Audit Activities.As the organization enters new States, this includes identifying new state requirements and developing associated Medicaid Compliance Plans, planning and hiring for appropriate staff as may be required and implementing and monitoring programs.

+ Other duties as assigned.



+ Bachelor’s Degree in Accounting or Finance


+ Masters Degree in Accounting or Finance



+ 7 – 10 years working in the Health Insurance Industry


+ 7 – 10 years in Compliance

To Include

+ 5 – 7 years in Management

+ 3 – 5 years in Project Management


+ 7 – 10 years in Medicaid Compliance or Government Compliance



+ Medicaid Compliance



+ Government Programs

+ Analytical and Logical Reasoning/Thinking

+ Analytical Skills

+ Relationship-builder with Unsurpassed Interpersonal Skills

+ Written & Oral Presentation Skills

+ Internal Controls

+ Auditing

+ Tolerance for Ambiguity

+ Problem Solving & Decision Making


+ Medicaid

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

EEO is The Law

Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity ( )

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Req ID: J134389

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