drjobs Senior Medicare Compliance Program Manager

Senior Medicare Compliance Program Manager

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1 Vacancy
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Job Location drjobs

Somerville, NJ - USA

Monthly Salary drjobs

Not Disclosed

drjobs

Salary Not Disclosed

Vacancy

1 Vacancy

Job Description

Site: Mass General Brigham Health Plan Holding Company Inc.


Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a notforprofit we support patient care research teaching and community service striving to provide exceptional care. We believe that highperforming teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.


This is a hybrid role that requires an onsite presence in the office 1x/month.

The Senior Medicare Compliance Program Manager is a key member of the Legal Regulatory Affairs and Compliance team to support the organizations Medicare Advantage line of business. This position will report directly to the Medicare Compliance Officer and take the lead on managing Medicare Advantage compliance and regulations. This position will provide complex project/program management related to risk regulations and audits on this line of business. The Senior Medicare Compliance Program Manager will be a member of the Medicare Advantage crossfunctional project team and their role will be to ensure compliance help to identify and mitigate risks of noncompliance and provide regulatory requirements and guidance on how to implement operationalize and optimize.

The Senior Medicare Compliance Program Manager is responsible for managing all of the key compliance initiatives integration/optimization business functions and needs to support the Medicare Advantage line of business. This person will do so by performing risk assessments and analysis to support proactive and reactive mitigation recommendations.

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham we are on the forefront of transformation with one of the worlds leading integrated healthcare systems. Together we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Our work centers on creating an exceptional member experience a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds experiences and skills.

We are pleased to offer competitive salaries and a benefits package with flexible work options career growth opportunities and much more.



Job Summary

Responsible for leading and overseeing the development implementation and monitoring of the hospitals Medicare compliance program. This role involves ensuring adherence to regulatory requirements mitigating risks and fostering a culture of compliance within the organization.

Does this position require Patient Care
No

Essential Functions
Develop and implement MGB Health Plans Medicare compliance program including policies procedures and guidelines.
Conduct regular risk assessments related to Medicare compliance.
Identify potential areas of noncompliance and implement strategies to mitigate risks.
Collaborate with various hospital departments to ensure integration of compliance requirements into their processes.
Conduct investigations into potential compliance violations related to Medicare.
Prepare and submit required reports to regulatory bodies and authorities as necessary.
Review and update Medicare compliance policies and procedures regularly.



Qualifications

Education
Bachelors Degree Related Field of Study required or Bachelors Degree Legal Studies required or Masters Degree Related Field of Study preferred

Can this role accept experience in lieu of a degree
No


Experience






  • At least 57 experience in healthcare compliance with a focus on Medicare regulations required


Knowledge Skills and Abilities

  • Indepth knowledge of Medicare rules guidelines and compliance expectations.
  • Strong understanding of healthcare laws and regulations.
  • Excellent communication and interpersonal skills.
  • Proven experience in developing and implementing compliance programs.
  • Detailoriented with strong analytical and problemsolving skills.



Additional Job Details (if applicable)



Remote Type

Hybrid



Work Location

399 Revolution Drive



Scheduled Weekly Hours

40



Employee Type

Regular



Work Shift

Day (United States of America)



EEO Statement:

Mass General Brigham Health Plan Holding Company Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religious creed national origin sex age gender identity disability sexual orientation military service genetic information and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process to perform essential job functions and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973 the Vietnam Veterans Readjustment Act of 1974 and Title I of the Americans with Disabilities Act of 1990 applicants who require accommodation in the job application process may contact Human Resources at (857)2827642.



Mass General Brigham Competency Framework

At Mass General Brigham our competency framework defines what effective leadership looks like by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half PeopleFocused half PerformanceFocused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance make hiring decisions identify development needs mobilize employees across our system and establish a strong talent pipeline.


Required Experience:

Manager

Employment Type

Full-Time

Company Industry

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