Medicaid Compliance Officer

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey's health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.

About the Role

What You'll Do

• Owns Medicaid compliance program design, monitoring, audit readiness, issue management, and remediation.
• Leads compliance with risk assessments and audit planning.
• Oversees intake, investigation, and resolution of potential non-compliance.
• Partners with Legal, Government Affairs, and business leaders on regulatory interpretation.
• Reports material compliance risks to senior leadership and the Chief Compliance Officer.
• Leads and develops compliance staff.
• Primary regulatory contact for Medicaid matters with regulatory agencies specifically DOBI, DMAHS, and Medicaid Fraud Division (MFD) and Office of Inspector General (OIG) and other related agencies.
• Coordinates state and federal regulatory and legislative activity impacting Medicaid.
• Oversees responses to regulatory and legislative complaints.
• Supports internal teams on Medicaid regulatory requirements.
• Primary regulatory contact for Medicaid matters with regulatory agencies specifically DOBI, DMAHS, and Medicaid Fraud Division (MFD) and Office of Inspector General (OIG) and other related agencies.
• Coordinates state and federal regulatory and legislative activity impacting Medicaid.
• Oversees responses to regulatory and legislative complaints.
• Supports internal teams on Medicaid regulatory requireme

What You Bring

Additional licensing, certifications, registrations:

Prefers Certified Compliance & Ethics Professional (CCEP)
Prefers Certified in Healthcare Compliance (CHC)
Prefers Leadership Professional in Ethics & Compliance (LPEC)

Knowledge:

• Knowledge of the Federal and State regulatory environment in the health insurance industry, with emphasis on:
• Federal and State benefit mandates
• False Claims Act
• AntiKickback Statute
• Medicaid requirements
• CMS requirements
• HIPAA
• ERISA
• Knowledge of the sources of legal and regulatory requirements relevant to the organization's business

Skills and Abilities:

Strong project management skills with the ability to manage multiple projects and priorities
Strong interpersonal skills, with the ability to work effectively at all levels of the organization
Excellent verbal and written communication skills, including the ability to communicate complex topics clearly
Strong analytical, organizational, planning, and problemsolving skills
Demonstrated ability to effectively lead and manage a team

Education/Experience:

Bachelor's degree preferred or relevant experience in lieu of a degree.
Prefers JD.
Minimum of 10 years of regulatory compliance experience in healthcare or legal.
Minimum of 5 years of managerial experience.
Requires experience working with regulatory agencies.

Why Horizon?

At Horizon, you'll do meaningful work that directly improves lives-while being supported by a missiondriven organization that values expertise, collaboration, and growth. We believe that when our people thrive, our communities do too. If you are passionate about making an impact, we'd love to hear from you!

Salary Range:

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

Disclaimer:

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.