Medicare Compliance Director
About The Position
The Medicare Compliance Director is responsible for overseeing the development, implementation, and monitoring of the Medicare Advantage compliance program. This role ensures adherence to applicable Centers for Medicare & Medicaid Services (CMS) requirements, federal regulations, and healthcare laws while supporting effective compliance operations across the organization. The Medicare Compliance Director will coordinate audits, risk assessments, corrective action plans, compliance training, investigations, regulatory reporting, and documentation while partnering with legal, finance, operations, and clinical teams to support compliant business processes.
Requirements
- Demonstrated expertise in Compliance Management and Regulatory Compliance within Medicare Advantage or health plan environments.
- Strong Legal Compliance background with the ability to interpret and apply CMS regulations and related healthcare laws.
- Advanced analytical skills to conduct risk assessments, evaluate audit findings, and develop data-driven mitigation strategies.
- Working knowledge of Finance as it relates to Medicare plan operations, including the impact of compliance requirements on financial performance.
- Relevant bachelor's degree.
- Proven experience leading compliance programs.
- Experience managing audits.
- Experience interacting with regulators or external reviewers.
- Excellent communication, presentation, and interpersonal skills.
- Ability to train and influence cross-functional teams.
- Strong organizational skills and attention to detail.
- Ability to manage multiple priorities in a fast-paced, mission-driven environment.
Nice To Haves
- Advanced degree such as JD, MHA, MPH, or MBA.
- Compliance certification such as CHC or CHPC.
Responsibilities
- Oversee and assist with the development, implementation, and monitoring of the Medicare Advantage compliance program.
- Ensure adherence to applicable CMS requirements and federal regulations.
- Manage compliance policies and procedures.
- Conduct risk assessments and internal audits.
- Monitor regulatory changes and assess their impact on Medicare Advantage operations.
- Coordinate corrective action plans related to identified compliance issues.
- Collaborate with legal, finance, operations, and clinical teams to support compliant workflows.
- Provide training and guidance on compliance standards.
- Prepare compliance reports for senior leadership and regulatory bodies.
- Lead investigations involving potential non-compliance.
- Maintain accurate and complete compliance documentation.
- Support compliance management activities related to Medicare Advantage, CMS regulations, healthcare laws, and internal auditing.
- Evaluate audit findings and support development of appropriate mitigation strategies.
- Promote a culture of integrity and accountability throughout the organization.
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What This Job Offers
Job Type
Full-time
Career Level
Director
