Sr. Medicare Compliance Program Manager

This is a hybrid role that requires onsite presence in the Assembly Row, Somerville office at least 1x / month.

Please make sure you read the following details carefully before making any applications.

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 world's 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 consciously inclusive environment where diversity is celebrated.

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

The Sr. Medicare Compliance Program Manager is a key member of the Legal, Regulatory Affairs and Compliance team to support the organization's 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 Sr. 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 Sr. 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.

Principal Duties and Responsibilities :

• Develops content and format for regulatory submissions, and related supplements and amendments.
• Advises Medicare Compliance Officer regarding the development and implementation of regulatory strategy, potential areas of regulatory concern, and new government / regulatory developments.
• In conjunction with the Medicare Compliance Officer, prepares, submits and responds to any objections from regulatory agencies regarding product filings;

negotiates directly with regulatory authorities regarding company's filings.

• Reviews applicable federal and state laws, rules, and regulations to keep apprised of new regulatory developments.
• Develops, initiates, maintains, and revises policies and procedures for the general operation of the Compliance Program.
• Collaborates with all operational departments to monitor compliance issues.
• Identifies potential areas of compliance vulnerability and risk; develops corrective action plans for resolution of problematic areas and provides general guidance on how to avoid or deal with similar situations in the future.
• Provides reports on a regular basis to the Medicare Compliance Officer.
• Ensures proper reporting of violations or potential violations to duly authorized enforcement agencies as appropriate and / or required.
• Institutes and maintains an effective compliance communication in the organization, including promoting heightened awareness of Standards of Conduct and understanding of new and existing compliance issues and related policies and procedures.
• Monitors, and as necessary, coordinates compliance activities of other departments to remain abreast of the status of all compliance activities and to identify trends.
• Conducts ongoing risk assessment, auditing, and monitoring.
• Conduct oversight activities of the business departments servicing the Medicare Advantage / Part D line of business.
• Initiate and remediate formal Corrective Action Plans (CAPs).
• Disseminate rules and requirements published by federal regulators (manual updates, Health Plan Management System (HPMS) memos).
• Work with internal business owners and external vendors to remediate compliance issues.
• Serve as a gatekeeper for HPMS access.
• Update policies and procedures.
• Prepare reports to various internal committee structures.
• Collaborate with the Medicare Compliance Officer to lead external CMS audit coordination efforts.
• Report data to CMS.
• Identify, initiate, and conclude process improvement opportunities.
• Build positive relationships with internal and external customers.
• Hold self and others accountable to meet commitments.
• Ensure diversity, equity, and inclusion are integrated as a guiding principle.
• Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
• Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.
• Other duties as assigned with or without accommodation.

Qualifications :

• Bachelor's Degree required or the equivalent combination of training and experience, plus 8 years of work experience in the federal payer insurance industry.
• 5+ years of regulatory and compliance experience within a health plan.
• Deep knowledge of rules and requirements governing the Medicare Advantage and Part D insurance programs.
• Experience in performing highly analytical and critical thinking work.
• Knowledge of Medicare Advantage preferred.
• Knowledge / experience with federal, state and payer-specific regulations preferred.
• Experience in health care compliance preferred.
• Experience contributing to a Medicare Advantage / Part D compliance team and program preferred.
• Certification in Healthcare Compliance (CHC) preferred.

Skills / Abilities / Competencies :

• Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback.
• Be accountable for delivering high-quality work. Act with a clear sense of ownership.
• Bring fresh ideas forward by actively listening to and working with employees and the people we serve.
• Excellent verbal and written communication skills.
• Demonstrate Mass General Brigham Health Plans core brand principles of always listening, challenging conventions, and providing value.
• Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner.
• Strong, demonstrated track record of an ability to execute on time, on budget, and on scope.
• Strong aptitude for technology-based solutions.
• Ability to inject energy, when and where it's needed.
• Current in healthcare trends.
• Demonstrated forward, visionary thinking; ability to see "what is" and envision "what could be."
• Ability to develop, introduce, defend, and gain support for new ideas and approaches.
• Excellent leadership skills and leadership track record.
• Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience.
• Ability to view the long-range trends and cycles of the business and industry and see the "big picture."
• Ability to apply a variety of strategic frameworks to analyze problems and to guide and develop solutions.
• Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy.
• Excellent interpersonal skills, including the ability to influence others at all levels of an organization.
• Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
• Unquestionable integrity.

EEO Statement :

Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead.

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.

Primary Location : MA-Somerville-MGB Health Plan at Assembly Row

Work Locations : MGB Health Plan at Assembly Row, 399 Revolution Drive, Somerville 02145

Job : Auditing / Compliance

Organization : Mass General Brigham Health Plan

Schedule : Full-time

Standard Hours : 40

Shift : Day Job

Employee Status : Regular

Recruiting Department : MGB Health Plan Compliance

Job Posting : Aug 29, 2024

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