Senior Medicare Compliance Program Manager
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Job Location:
Somerville, NJ - USA
Monthly Salary:
$ 99465 - 141804
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
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 not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham we are at 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.
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 Senior Director of Medicare Regulatory Compliance 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 cross-functional 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 of business functions and supporting the Medicare Advantage line of business. This person will do so by performing risk assessments and analysis to support proactive and reactive mitigation recommendations.
Responsible for leading and overseeing the development implementation and monitoring of the MGB Health Plans Medicare compliance program. This role involves ensuring adherence to regulatory requirements mitigating risks and fostering a culture of compliance within the organization.
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 non-compliance and implement strategies to mitigate risks.
-Collaborate with various health plan 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 required; Masters Degree preferred
Experience
- At least 5-7 years of experience in health plan compliance with a focus on Medicare (Medicare Advantage and/or DSNP) regulations required
Knowledge Skills and Abilities
- In-depth 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.
- Detail-oriented with strong analytical and problem-solving skills.
Additional Job Details (if applicable)
Working Conditions:
- This is a hybrid role that requires an on-site presence at the office in Assembly Row Somerville roughly 2- 3x/month
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$99465.60 - $141804.00/AnnualGrade
8EEO Statement:
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 People-Focused half Performance-Focused) 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
Key Skills
About Company
Patients at Mass General have access to a vast network of physicians, nearly all of whom are Harvard Medical School faculty and many of whom are leaders within their fields.
