Senior Compliance Lead

Aetna Inc. • Minneapolis, MN 55415

Posted 2 weeks ago

Job Description

Job Description


Office Based in Plymouth, MN (Greater Minneapolis MN area)

Exciting opportunity for a Plan Medicare Compliance Officer position at Aetna!

The Plan Medicare Compliance Officer for Allina Health | Aetna oversees and coordinates the Medicare Compliance Program and the Anti-Fraud Program for Allina Health|Aetna's Medicare Advantage (Part C) and Prescription Drug (Part D) lines of business.

This position will ensure that this program fulfills CMS requirements as described in CMS regulatory guidance such as Chapters 9&21, Compliance Program Effectiveness and executes on the required regulatory requirements that include distribution and validation of regulatory guidance, development of a regulatory risk assessment with periodic reviews, development and execution of an annual work plan of auditing and monitoring which includes First Tier, Downstream and Related Entities (FDRs) and ongoing communication to leadership and the Allina-Aetna Board of Directors regarding Medicare compliance activities and risks.

Fundamental Components:

* The Plan Compliance Officer (PCO) for Allina Health | Aetna (AHA) directs and coordinates on behalf of the Medicare Compliance Officer (MCO), the Medicare Compliance Program and the Fraud, Waste and Abuse (FWA) Program for AHAs Medicare Advantage (Part C) and Prescription Drug (Part D) business.

* The PCO must ensure that the requirements of an effective Medicare Compliance program as expressed by CMS in Ch 9&21 as well as other regulatory guidance are met for AHA and that Aetna as a FDR to AHA is meeting these compliance obligations. The PCO will work closely with staff at AHA and Aetna to ensure that the specific elements of a Medicare Compliance program are achieved and maintained.

* Key attributes include distribution & validation of regulatory alerts, risk assessment, oversight and/or performance of auditing & monitoring, evaluating risks and ensuring documentation to demonstrate an effective Medicare Compliance program.

* Position promotes compliance with CMS regulations and related-company policies, including Aetnas and AHAs Code of Conduct.

* The PCO reports to the Senior Director of Compliance Program Effectiveness who is a direct report to Aetnas Chief Medicare Officer who is the MCO for AHA.

* The MCO or designee, the PCO, reports at least quarterly to the Board of Directors and/or the CEO of AHA on matters pertaining to the Medicare Compliance program and its effectiveness.

* Implements & maintains an effective Medicare Compliance program for AHA

* Monitors CMS regulations & provides direction to ensure Aetnas administrative & operational activities as a FDR comply with regulations for AHA

* Maintains current knowledge & expertise in Medicare Compliance with a focus on Medicare Compliance Program Effectiveness

* Conducts monitoring & auditing as outlined in Medicare Compliance Work Plan; requests corrective action where necessary and monitors implementation

* Builds and maintains positive, productive relationships with internal and external constituents

* Able to remove significant barriers to drive decision-making and influence ethical and compliant outcomes necessary to accomplish goals.

* Anticipate and respond to future risk situations

* Strong Acumen of Medicare Compliance and FDR requirements with ability to address issues

* Serve as an Aetna spokesperson

* Demonstrate critical thinking, drives and executes strategy

* Creates ownership, promotes collaboration among stakeholders

* Institutionalize Medicare compliance as a core competency


* 8+ years of work experience with a minimum of 3-5 years in regulatory/compliance management in Medicare Compliance or experience working on Medicare Compliance program effectiveness (CPE).

* Strong leadership skills in working cross functionally and in project management in a complex corporate environment.


The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.


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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