Senior Director, Health & Wellness Billing Compliance

Senior Director, Health & Wellness Billing Compliance

  • Location BENTONVILLE, AR
  • Career Area Legal, Compliance and Ethics
  • Job Function Compliance
  • Employment Type Full Time
  • Position Type Salary
  • Requisition 1000278BR

What you'll do at

•Develops and oversees the Health and Wellness Billing Compliance program by maintaining a thorough understanding of the regulatory requirements for Pharmacy, Optical, and Clinics to receive payments from 3rd party payers (for example, Medicare, Medicaid, Tricare, Managed Care Plans); monitoring compliance with regulatory requirements performed by external providers on behalf of Walmart; reviewing, assessing, and analyzing the overall billing and documentation system for potential compliance issues and non-compliance; supporting the development of training related to billing activities (for example, compliance with Fraud, Waste & Abuse (FWA) requirements generally, False Claims Act, Anti-Kickback, Conflict of Interest); ensuring the execution of a program that meets all required elements of an effective compliance program to ensure compliance with all billing and related requirements, including enrollment requirements, contractual obligations, and conditions of participation; and assessing new business opportunities to provide guidance to the business regarding regulatory requirements to operate effectively.
•Designs strategies and procedures for Walmart and Sam's Club to manage new regulations and changing regulations; directing the research and analysis of health and wellness state and federal statutes and regulations; collaborating with cross-functional teams on the impact of new and changing regulations in health and wellness; directing the design and execution of training and education for health and wellness associates on compliance policies and procedures; and serving as chair of Compliance Committee Work Group.
•Develops compliance risk assessment processes and corrective action and mitigation strategies by overseeing thorough risk and maturity assessments of the Pharmacy, Optical, and Clinics billing compliance programs to determine potential opportunities for improvement; utilizing results and analysis of information related to existing and future compliance concerns; and leading cross-functional teams (for example, Legal, Health and Wellness Operations, and corporate Operations Compliance) to direct response to compliance issues.
•Directs compliance investigations and audits by designing and developing strategies, protocols, and procedures for investigating and responding to health and wellness compliance concerns across Walmart and Sam's Club; advising leadership on compliance matters and trends; developing and directing implementation of mitigation strategies; directing investigations; and directing the development of communications in response to compliance concerns.
•Provides overall direction by analyzing business objectives and customer needs; developing, communicating, building support for, and implementing business strategies, plans, and practices; analyzing costs and forecasts and incorporating them into business plans; determining and supporting resource requirements; evaluating operational processes; measuring outcomes to ensure desired results; identifying and capitalizing on improvement opportunities; promoting a customer environment; and demonstrating adaptability and sponsoring continuous learning.
•Develops and implements strategies to attract and maintain a highly skilled and engaged workforce by diagnosing capability gaps; recruiting, selecting, and developing talent; supporting mentorship, workforce development, and succession planning; and leveraging the capabilities of new and existing talent.
•Cultivates an environment where associates respect and adhere to company standards of integrity and ethics by integrating these values into all programs and practices; developing consequences for violations or non-compliance; and supporting the Open Door Policy.
•Develops and leverages internal and external partnerships and networks to maximize the achievement of business goals; engaging key stakeholders in the development, execution, and evaluation of appropriate business plans and initiatives.

Minimum Qualifications

• Bachelor's degree in Business, Healthcare, Compliance, or related field and 4 years’ experience in healthcare, medical billing, audit, compliance, legal, or related field OR 6 years’ experience in healthcare, medical billing, audit, compliance, legal, or related field.

• 2 years of supervisory experience.

Preferred Qualifications

• 10+ years’ experience with a pharmacy billing compliance program or related healthcare organization

• Experience working for a governing body such as Centers for Medicare & Medicaid (CMS), Office of Inspector General (OIG), Department of Justice (DOJ), etc.

• Juris Doctorate OR Master’s degree in Health Care Administration (HCA) or other related healthcare field

• Certified in Health Care Compliance (CHC), Internal Audit (CIA) or Public Accountant (CPA)

About Walmart

At Walmart, we help people save money so they can live better. This mission serves as the foundation for every decision we make, from responsible sourcing to sustainability—and everything in between. As a Walmart associate, you will play an integral role in shaping the future of retail, tech, merchandising, finance and hundreds of other industries—all while affecting the lives of millions of customers all over the world. Here, your work makes an impact every day. What are you waiting for?

Hello, NW Arkansas

With over 200 miles of trails, an emerging locally-sourced food scene, the world-renowned Crystal Bridges Museum—NWA has something for everyone.

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All the benefits you need for you and your family

  • Multiple health plan options
  • Vision & dental plans for you & dependents
  • Associate discounts in-store and online
  • Financial benefits including 401(k), stock purchase plans and more
  • Education assistance for Associate and dependents

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