Medicare Benefits Standards & Guidance Lead Director ID-22396

Job Description
Welcome to Aetna, where we are dedicated to helping people live healthier lives. As the Medicare Benefits Standards & Guidance Lead Director, you will be a key member of our team responsible for ensuring compliance with federal and state regulations and developing guidance for our Medicare benefits programs. We are looking for a highly skilled and experienced individual who is passionate about making a positive impact on the lives of our Medicare members. If you have a strong understanding of Medicare regulations, excellent leadership skills, and a drive for continuous improvement, we encourage you to apply for this exciting opportunity.

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Develop and maintain comprehensive knowledge of federal and state regulations related to Medicare benefits programs.
Monitor and interpret changes in regulations and communicate updates to relevant teams.
Ensure compliance with all Medicare regulations and guidelines in the development and implementation of benefits programs.
Collaborate with cross-functional teams to develop and implement processes and procedures that align with regulatory requirements.
Lead and oversee the development of guidance and training materials for Medicare benefits programs.
Provide guidance and support to team members on complex regulatory issues and inquiries.
Conduct regular audits and reviews to identify any compliance gaps and develop action plans to address them.
Serve as the primary point of contact for regulatory agencies and represent the company in audits and inquiries.
Keep up-to-date with industry best practices and make recommendations for continuous improvement of our Medicare benefits programs.
Collaborate with legal and compliance teams to ensure all policies and procedures are in line with regulatory requirements.
Develop and maintain relationships with external stakeholders, such as government agencies and industry associations.
Stay informed about emerging trends and changes in the healthcare industry that may impact Medicare benefits programs.
Champion a culture of compliance and ensure all team members are trained and educated on regulations and guidelines.
Prepare and present reports on compliance activities and metrics to senior leadership.
Proactively identify and mitigate potential compliance risks.
Lead and mentor team members to ensure high performance and development opportunities.
Foster a positive and collaborative work environment that promotes teamwork and open communication.
Where is this job?
This job opening is listed as 100% remote
Job Qualifications
Extensive Knowledge Of Medicare Regulations And Requirements: The Ideal Candidate Should Have A Strong Understanding Of Medicare Policies, Guidelines, And Standards Set By The Centers For Medicare And Medicaid Services (Cms).

Experience In Healthcare Compliance: The Medicare Benefits Standards & Guidance Lead Director Should Have A Background In Healthcare Compliance, With A Focus On Medicare. This Includes Experience With Audits, Risk Assessments, And Developing Compliance Programs.

Leadership And Management Skills: As A Lead Director, The Candidate Should Possess Strong Leadership And Management Skills To Guide A Team Of Professionals In The Development, Implementation, And Monitoring Of Medicare Benefits Standards And Guidance.

Analytical And Problem-Solving Abilities: This Role Requires The Ability To Analyze Complex Data, Identify Areas Of Improvement, And Develop Solutions To Ensure Compliance With Medicare Standards And Guidance.

Excellent Communication And Collaboration Skills: The Candidate Should Have Excellent Communication Skills To Effectively Collaborate With Cross-Functional Teams, Present Findings And Recommendations To Senior Management, And Communicate With External Stakeholders Such As Cms.

Required Skills
Quality Assurance

Project Management

Data Analysis

Contract Negotiation

Compliance Management

Risk assessment

Policy Development

Stakeholder engagement

Medicare Advantage

Healthcare Industry Knowledge

Medicare Regulations

Soft Skills
Communication

Conflict Resolution

Emotional Intelligence

Leadership

Time management

Interpersonal Skills

creativity

Teamwork

Adaptability

Problem-Solving

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