Medicare Programs Compliance Lead (Hybrid)

Blue Cross and Blue Shield of Kansas Inc.; Chicago (IL); Hybrid; USD 114,000 - 154,000; Full time

Benefits offered by this job

Annual bonus incentive

Medical/dental/vision insurance

11 holidays

401(k) matching

Paid time off

Job summary

Blue Cross and Blue Shield of Kansas Inc. is seeking a Government Programs Compliance Lead to support the Medicare Compliance Officer by implementing CMS-aligned programs and seven elements across Part C and Part D.

The role focuses on policies, training, monitoring, audits, and remediation, partnering with operational teams to embed compliant processes. The position emphasizes risk assessment, regulatory gap analyses, CAP design, and actionable guidance for claims, pharmacy, utilization

Qualifications

• Deep knowledge of CMS Medicare regulations and guidance including 42 CFR Parts 422/423, CMS manuals, HPMS guidance, and audit protocols.
• Understanding of the 7 Elements of an Effective Compliance Program and how to operationalize them.
• Knowledge of Medicare Part D and/or MA-PD program requirements including enrollment, claims, formulary, pharmacy operations, and member protections.
• Knowledge of Fraud, Waste, and Abuse requirements and detection methodologies.
• Ability to conduct regulatory gap analyses and translate requirements into actionable controls.
• Strong auditing and monitoring capabilities and data-driven oversight.
• Knowledge of CMS audit processes and audit-readiness expectations.
• Ability to interpret regulatory requirements for practical guidance to stakeholders.
• Strong governance and reporting skills including board-level oversight.
• Effective communication and documentation skills.
• Knowledge of privacy and data governance in Medicare contexts.
• Ability to manage internal stakeholders and FDRs.

Responsibilities

• Support the Medicare Compliance Officer in executing and improving the compliance program aligned with CMS requirements and seven elements.
• Operationalize program elements: policies, training, monitoring, audits, and corrective actions across Part C and Part D.
• Serve as primary compliance liaison to operational teams ensuring regulatory alignment in day-to-day activities.
• Assess compliance risks in core areas impacting claims, utilization management, pharmacy, enrollment, and grievances/appeals.
• Support ongoing risk assessment activities, CAP development, and reporting to committees and leadership.

Skills

CMS Regulations

7 Elements

Part D/MA-PD

FWA Knowledge

Auditing & Monitoring

CAPs Design

CMS Audits

Governance & Reporting

Clear Communication

Privacy & Data Governance

Stakeholder Management

Analytical Skills

Integrity & Judgment

Education

Bachelor's degree

Job description

Blue Cross and Blue Shield of Kansas Inc. is seeking a Government Programs Compliance Lead to support the Medicare Compliance Officer by implementing CMS-aligned programs and seven elements across Part C and Part D.

The role focuses on policies, training, monitoring, audits, and remediation, partnering with operational teams to embed compliant processes. The position emphasizes risk assessment, regulatory gap analyses, CAP design, and actionable guidance for claims, pharmacy, utilization