Senior Health Plan Regulatory Audit Program Manager

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 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.

Leads MGB Health Plans audit readiness and execution for all lines of business (Commercial Medicaid DSNP and Medicare Advantage) partnering across internal departments external vendors and regulators/auditors. Success in this role is measured by on-time high-quality submissions well-managed live audit sessions clear status/risk reporting to leadership and timely closure of audit findings through corrective action planning.

This position owns the end-to-end external audit life cycle including audit intake and planning coordination of SMEs and vendors evidence/artifact management response and issue resolution during fieldwork and tracking corrective action plans through closure. This role sits within Legal Regulatory Affairs and Compliance and reports to the Government Programs Compliance Officer.

The Sr. External Audit Program Manager is responsible for cataloging the current audits conducted by MGBHPs regulators creating reasonable project plans to prepare MGBHP for audits hosting and managing meetings with applicable MGBHP departments and external vendors and managing project plans to ensure readiness for external audits. Once audits kick off this role will be responsible for setting up shared sites to store audit artifacts project-managing department and vendor activities facilitating internal and vendor meetings serving as liaison between MGBHP and auditors and reporting status updates progress risks etc. to the LRAC department business departments and senior leaders.

Essential Functions
-Maintains an external audit inventory and calendar including audit type regulator key milestones required data/evidence and involved departments/vendors.
-Defines submission templates and assembly standards (format naming conventions version control) and coordinates timely delivery of audit submissions supplements and amendments.
-In conjunction with the Government Programs Compliance Officer interacts with regulatory agencies to discuss audit submissions live audit sessions reports corrective actions and related matters.
-Reviews applicable federal and state laws rules and regulations to keep apprised of new regulatory developments and how they may impact audit protocols and performance.
-Develops initiates maintains and revises policies and procedures for external audit-related activities.
-Collaborates with all operational departments to evaluate and enhance audit readiness.
-Produces and distributes routine audit status reports (milestones risks issues owners due dates) to the Government Programs Compliance team business areas and senior leadership.
-Conducts ongoing risk assessment of audit readiness and performance strengths and gaps that may be detected during an audit.
-Partners with business owners and external vendors to remediate audit readiness gaps and track corrective action plans (CAPs) through documented closure.

Education

• Bachelors Degree required; equivalent years of experience can be considered in lieu of a degree

Experience

• At least 8-10 years of experience in the federal and state payer insurance industry required
• At least 5-7 years of regulatory and compliance experience within a health plan required
• At least 2-3 years of deep knowledge of rules and requirements governing Medicare Advantage Part D Dual and Medicaid ACO insurance programs required
• At least 2-3 years of experience in performing highly analytical and critical thinking work including proficiency in Microsoft 365 tools required
• At least 1-2 years of knowledge/experience with federal state and payer-specific regulations preferred

Knowledge Skills and Abilities

• Exercise self-awareness monitor impact on others be receptive to and seek out feedback and use self-discipline to adjust to feedback.
• Build positive relationships with internal and external customers.
• Proficient user in Microsoft Office 365 resources
• Be accountable for delivering high-quality work. Act with a clear sense of ownership.
• Demonstrate Mass General Brigham Health Plans core brand principles of always listening challenging conventions and providing value.

Working Conditions

• This is a hybrid role that requires an on-site presence at the office in Assembly Row Somerville roughly 2- 3x/month

Hybrid

399 Revolution Drive

40

Regular

Day (United States of America)

Pay Range

$99465.60 - $141804.00/Annual

Grade

8

At Mass General Brigham we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive and any offer extended will take into account your skills relevant experience if applicable education certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however it does not encompass all elements contributing to your total compensation addition to competitive base pay we offer comprehensive benefits career advancement opportunities differentials premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

8925 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 .

Mass General Brigham Competency Framework