Medicaid Compliance Officer
Horizon Blue Cross Blue Shield of New Jersey, New York, NY, United States
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
• Accountable for the oversight, implementation, and execution of the Medicaid regulatory compliance program.
What You'll Do
Owns Medicaid compliance program design, monitoring, audit readiness, issue management, and remediation.
Leads compliance 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 regulator and legislative complaints.
Supports internal teams on Medicaid regulatory requirements
What You Bring
HSD or GED required
Bachelor's degree preferred or relevant experience in lieu of a degree
Why Horizon?
At Horizon, you'll do meaningful work that directly improves lives-while being supported by a mission-driven 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:
$154,800 - $211,260
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.
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
• Accountable for the oversight, implementation, and execution of the Medicaid regulatory compliance program.
What You'll Do
Owns Medicaid compliance program design, monitoring, audit readiness, issue management, and remediation.
Leads compliance 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 regulator and legislative complaints.
Supports internal teams on Medicaid regulatory requirements
What You Bring
HSD or GED required
Bachelor's degree preferred or relevant experience in lieu of a degree
Why Horizon?
At Horizon, you'll do meaningful work that directly improves lives-while being supported by a mission-driven 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:
$154,800 - $211,260
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.