Director, Legal, Regulatory Affairs, and Compliance

Mass General Brigham•Somerville, MA

2d•$124,342 - $180,898•Hybrid

About The Position

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 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 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 Director, LRAC serves as Mass General Brigham Health Plan’s Government Programs Compliance Officer and plays a crucial role in managing an effective compliance program for the Medicaid, Medicare Advantage (MA), One Care and Senior Care Options lines of business. This role requires a deep understanding of the Medicare Advantage and Medicaid compliance landscapes, healthcare regulations, and a strong background in healthcare management. Responsible for managing regulatory compliance, and overseeing risk management initiatives. This position involves collaboration with various departments to ensure adherence to healthcare laws, regulations, and ethical standards.

Requirements

Bachelor's required; Master's degree preferred
At least 8-10 years of Medicare health plan compliance management experience required
Knowledge of a Medicare Advantage plan is highly preferred
At least 3-5 years of management experience required
Strong knowledge of federal, state, and local healthcare regulations, such as Health Insurance Portability and Accountability Act , Medicare/Medicaid rules, and Joint Commission standards.
Familiarity with accreditation processes and standards.
Excellent leadership, communication, and interpersonal skills to effectively collaborate with multiple stakeholders and teams.
Analytical and problem-solving abilities to identify compliance risks and develop effective solutions.
Ability to maintain confidentiality, exercise good judgment, and demonstrate ethical conduct.

Nice To Haves

Knowledge of a Medicare Advantage plan is highly preferred

Responsibilities

Develop and implement the annual Medicaid, Medicare Advantage, and Duals Compliance Program (Government Programs Compliance Program) and workplans, ensuring compliance with regulatory requirements, optimizing plan compliance performance, and coordinating with various teams to enhance the overall quality of care and member satisfaction
Implement and lead external auditing and internal monitoring activities of the Government Programs Compliance Program, including CMS and EOHHS audits as well as the monitoring and auditing of vendors. Ensure engagements are completed objectively, professionally, and in accordance with industry audit standards.
Manage and report an annual evaluation on the Government Programs Compliance Program and present to the Executive Committee and Board of Directors.
Work collaboratively with department heads to develop, update, and enforce policies and procedures to ensure compliance with legal and regulatory requirements.
Identify and assess areas of compliance risk for the organization and work with the business to develop corrective action plans.
Develop and/or ensure internal controls are capable of preventing and detecting significant instances or patterns of illegal, unethical, or improper conduct.
Complies with all policies and procedures
Performs other duties as assigned