Senior Medicare Compliance Director

Blue Cross Blue Shield of Arizona; Phoenix (AZ); Hybrid; USD 120,000 - 170,000; Full time

Job summary

Blue Cross Blue Shield of Arizona is seeking a senior leader to oversee Medicare compliance programs and act as the primary CMS liaison for all Medicare products. The role involves coordinating audits, defining program work plans, and reporting to the MediSun Board.

You will guide FDR oversight, lead compliance teams, and ensure regulatory changes are integrated into programs. A strong background in healthcare policy and at least 5–7 years in compliance is required, with a Bachelor’s degree.

Qualifications

• 5+ years of management experience.
• 7+ years of experience in corporate compliance.
• 5+ years of experience in Medicare Advantage program compliance.
• Bachelor’s Degree in business, healthcare policy, judicial studies, ethics or related field.

Responsibilities

• Develops and maintains Medicare Compliance Programs and Work Plans, including training for employees and FDRs.
• Reports to the MediSun Board and committees on Medicare Compliance activities.
• Acts as compliance liaison for Medicare products with CMS and maintains relationships with CMS offices.
• Prepares for and responds to CMS and other external audits.
• Chairs Medicare Compliance committees for appropriate oversight.
• Oversees Medicare Program requirements, such as HPMS submissions.
• Evaluates regulatory changes and CMS guidance on program requirements.
• Oversees investigation reports and maintains records of compliance activity.
• Oversees identification, assessment, and monitoring of Medicare compliance risks.
• Oversees corrective action plans from audits and investigations.
• Manages day-to-day departmental administration and staff performance.
• Participates in strategic planning to achieve BCBS AZ goals.
• Conducts performance evaluations and coordinates training needs.

Skills

Management experience

Corporate compliance

Medicare Advantage compliance

Education

Bachelor’s Degree in business, healthcare policy, judicial studies, ethics or related field

Job description

Blue Cross Blue Shield of Arizona is seeking a senior leader to oversee Medicare compliance programs and act as the primary CMS liaison for all Medicare products. The role involves coordinating audits, defining program work plans, and reporting to the MediSun Board.

You will guide FDR oversight, lead compliance teams, and ensure regulatory changes are integrated into programs. A strong background in healthcare policy and at least 5–7 years in compliance is required, with a Bachelor’s degree.