Senior Compliance Officer
About The Position
We are seeking an experienced and dynamic Senior Compliance Officer to support and administer our corporate compliance program and our Medicare and Medicaid compliance obligations. Reporting directly to the SVP of Legal, this role is instrumental to supporting HIPAA and federal healthcare program compliance across our company, with a particular focus on two things: our obligations as a delegated entity to health plan clients, and our oversight of third-parties and subcontractors we rely on – including business associates under HIPAA and vendors that qualify as first tier, downstream, or related entities (FDRs). The ideal candidate has a strong command of Medicare and Medicaid regulatory requirements, experience in startups or high-growth environments, and the judgment to build practical compliance controls that scale with the business.
Requirements
- 8+ years of regulatory affairs/compliance experience within Medicare or Medicaid.
- Must include prior experience at a start-up or high-growth company, ideally at the intersection of health care, retail, and financial technology.
- 3+ years of hands-on experience with FDR/vendor oversight and CMS or First-Tier Entity audits.
- Working knowledge of 42 CFR Part 422/423 (Medicare Advantage and Part D regulations) and CMS 201.
- Experience with a compliance management or GRC platform to support process automation and regulatory report tracking.
- Demonstrated ability to independently own a compliance function with minimal support staff.
- Act as a business enabler with a solutions-oriented approach to compliance.
- Strong written and verbal communication skills for interactions with regulators, auditors, and external partner.
- Legal authorization to work in the US is required.
- Candidates should be comfortable with, and equipped to work within, a distributed remote team, including having reliable internet access and basic home office equipment.
Nice To Haves
- Bachelor's degree or equivalent preferred.
- Data privacy experience is a plus, with some overlap with existing team members.
- AML/BSA experience is a plus; training can be provided internally.
- CHC (Certified in Healthcare Compliance) or CHPC preferred.
Responsibilities
- Manage the third-party oversight program, including due diligence, risk tiering, ongoing monitoring, and annual attestation for FDRs and Medicaid subcontractors.
- Partner with Legal on business associate agreements, delegation agreements, and required regulatory flow-down provisions in vendor agreements.
- Conduct exclusion and preclusion screening of employees, contractors, and FDRs against the OIG LEIE and SAM.gov, the CMS Preclusion List, and applicable state Medicaid exclusion lists; automating the process with IT and confirming results monthly.
- Lead privacy and security incident response: intake, investigation, four-factor breach risk assessment, notification decisions, and reporting to plan clients under our delegation agreements; in cooperation with compliance colleagues across the company.
- Track incidents to closure, including root cause analysis and corrective action.
- Provide strong customer communication, expectation management, and know when to push back on client challenges.
- Draft and maintain compliance policies and procedures.
- Design and present compliance training in-house, developing internal capabilities rather than relying on outside consultants.
- Maintain effective lines of communication for compliance issue reporting, ensuring cross department understanding of key compliance risks and what each department must do to comply.
- Conduct internal risk assessments and execute an annual monitoring and auditing work plan.
- Support delegation oversight audits by health plan clients and regulatory examinations by agencies.
- Own corrective action plans through validation and closure, whether self-identified or raised by a client or regulator.
- Prepare, review, and submit required regulatory reports and filings ahead of deadlines.
- Support evermore’s clients’ CMS filing obligations, including benefit specifications and supporting documentation.
- Review and distill program explainers into clear actionable guidance for internal teams.
- Work at the speed of product, providing timely compliance input during product design to accelerate go-to-market timelines.
Benefits
- Medical, Dental, and Vision insurance with 90% paid employer premium contributions for all tiers
- 100% Employer Paid Short-Term & Long-Term Disability
- 100% Employer Paid Basic Life Insurance Policy
- Employee Assistance Program (EAP)
- 401(k) Program
- Discretionary PTO
- Paid holidays
- Parental Leave
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Associate degree
