Senior Compliance Lead

Aetna Inc. • Saint Joseph, MO 64503

Posted 2 weeks ago

Job Description

Job Description


Preference is to be office based in Atlanta, GA but open to other Aetna offices and telework for right candidate

The Plan Compliance Officer for Dual Eligible Special Needs Plans (D-SNP) directs and coordinates, on behalf of the Medicare Compliance Officer, the Medicare Compliance Program and the Fraud, Waste and Abuse Program, for D-SNP contracts in LA, MO, KS and GA (additional markets be assigned or market assignments may change).

The Plan Compliance Officer must ensure that the requirements of an effective Medicare Compliance program, as expressed by CMS in Chapters 9 & 21 as well as other regulatory guidance, are met for the D-SNPs. This role will work collaboratively with Plan staff, management and corporate support services to ensure that the specific elements of a Medicare Compliance program are achieved and maintained.

Key attributes for this position include the distribution and validation of regulatory guidance, oversight and/or performance of auditing and monitoring, evaluating risks, and ensuring documentation to demonstrate an effective Medicare Compliance program. This position promotes compliance with CMS regulations and related-company policies, including Aetnas Code of Conduct.

Fundamental Components:

* Leads, implements and maintains an effective Medicare Compliance program for the D-SNP contracts in LA, MO, KS, and GA-

* Maintains current working knowledge and expertise in Medicare Compliance with a strong focus on Medicare Compliance Program Effectiveness and the attributes of a D-SNP.

* Applies expert industry and compliance knowledge to lead and address compliance and compliance related matters

* Conducts activities, including monitoring and auditing, as outlined in Medicare Compliance Work Plan; proposes corrective action where necessary and monitors implementation of such corrective action

* Builds and maintains positive, productive relationships with internal legal, compliance, audit, and business partners at all organizational levels; able to remove barriers, drive decision-making and influence ethical and compliance outcomes.

* Builds and maintains positive, productive relationships with CMS and other applicable regulatory bodies and external constituents.

* Independently identifies and assesses emerging compliance risks and appropriately engages internal stakeholders in risk mitigation activities and escalates to senior management, as needed.

* Acts as a compliance resource and subject matter expert for colleagues and the D-SNPs and effectively guides individuals or teams.

* Exhibits fact-based judgment and flexibility to adapt to shifting strategic priorities.

* Exhibits the following behaviors: - Anticipate and respond to future risk situations

* Strong acumen of Medicare Compliance and FDR requirements

* Strong acumen of Medicare Advantage and DSNP business

* Apply knowledge to address issues - Serve as an Aetna spokesperson

* Demonstrate critical thinking

* Drive and execute strategy

* Creating ownership

* Promote collaboration among stakeholders

* Institutionalize Medicare compliance as a core competency

* Excellent verbal and written communication skills


8+ years experience in a regulatory compliance position in healthcare, insurance or financial services or work experience in a relevant business area.

Experience leading complex projects.


The highest level of education desired for candidates in this position is a Master's degree.


Functional - Legal/Compliance/7-10 Years



Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.


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