This role will act as CHRISTUS Health Plan's Medicare Compliance Officer. This full time leadership position will contribute to the organization's mission and vision by planning, designing, implementing and maintaining of a Health Plan compliance program designed to comply with CHRISTUS Health's Code of Ethics and all applicable state and federal laws and regulations. This position requires an in-depth understanding of the legal and regulatory environment affecting health plans and is accountable for the oversight of all health plan compliance program efforts, including the Special Investigative Unit (SIU).
This position manages the interface with the Centers for Medicare and Medicaid Services (CMS), and all other federal and state regulatory agencies that provide health plan oversight. This position oversees the implementation of new and revised program requirements and is responsible for the ongoing maintenance of compliance activities. This position must be familiar with the CHRISTUS Health business, ethics and operational practices.
The Health Plan Compliance program includes the implementation and maintenance of proper preventive, detective and remedial programs and controls; the execution of relevant policies and procedures; training and educating the workforce; implementing an effective communications program; ensuring effective testing, auditing, monitoring, tracking and reporting; and remediating control deficiencies. The Health Plan Compliance program encompasses many subject matter areas, including all applicable, state Medicaid, CMS Medicare regulations, DoD TRICARE (US Family Health Plan), Health Insurance Exchange, compliance training, Medicare-related compliance investigations, Medicare-related fraud, waste and abuse, exclusion lists, and third-party compliance oversight, among others.
Our Mission: WHY WE EXIST. To extend the healing ministry of Jesus Christ. Our Core Values: WHAT WE BELIEVE IN.DIGNITY Respect for the worth of every person, recognition and commitment to the value of diverse individuals and perspectives, and special concern for the poor and underserved. INTEGRITY Honesty, justice, and consistency in all relationships. EXCELLENCE High standards of service and per...formance. COMPASSION Service in a spirit of empathy, love, and concern. STEWARDSHIP Wise and just use of talents and resources in a collaborative manner.Our Vision: WHAT WE ARE STRIVING TO DO. CHRISTUS HEALTH, a Catholic health ministry, will be a leader, a partner and an advocate in the creation of innovative health and wellness solutions that improve the lives of individuals and communities so that all may experience God's healing presence and love. Our Name and Symbol:WHO WE ARE. CHRISTUS is Latin for "Christ," and proclaims publicly the core of our mission. OUR NAME choice also recognizes the heritage of our two congregational sponsors, the Sisters of Charity of the Incarnate Word in Houston and San Antonio. Jesus Christ is the Incarnate Word, the Word of God made flesh. It is, therefore, only fitting that it is in another form of His name that our health ministries are called together. OUR SYMBOL Reflects the healing ministry of Jesus Christ - a combination of a medical cross and a religious cross. The flowing banner on the cross is a common symbol of the risen Christ, while the royal purple signifies Christ. The flowing banner also conveys a sense of motion as we move forward into a new era of service to our communities.