Senior Dual Compliance Program Manager

Mass General Brigham•Somerville, MA

2d•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. Responsible for ensuring that the organization's programs and services for dual-eligible beneficiaries (those eligible for both Medicare and Medicaid) comply with all relevant regulations, laws, and industry standards. This role is responsible for overseeing, implementing, and monitoring the organization's compliance with federal and state regulations related to the Medicare and Medicaid programs. This role involves developing and implementing compliance policies, monitoring operations, and collaborating with various stakeholders to uphold ethical and legal standards, as well as collaborating with the Medicare Compliance Officer and Internal Audit team regarding audits and assessments to ensure adherence to regulations.

Requirements

Bachelor's Degree required
At least 5-7 years of experience in health plan compliance, with a focus on Medicare (DSNP and/or Medicare Advantage) regulations required
DSNP compliance experience highly preferred
Strong analytical and problem-solving skills.
Excellent communication and interpersonal skills.
Strong, demonstrated track record of an ability to execute on time, on budget, and on scope.
Strong aptitude for technology-based solutions.
Current in healthcare trends.

Nice To Haves

DSNP compliance experience highly preferred

Responsibilities

Leveraging the existing Medicare and Medicaid compliance program tools, further develop, implement, and maintain a comprehensive compliance program specific to the dual-eligible population, incorporating both Medicare and Medicaid requirements.
Stay current with all regulations, guidelines, and changes in Medicare and Medicaid related to dual-eligible beneficiaries.
Develop, review, and revise compliance policies, procedures, and protocols, ensuring alignment with federal and state regulations.
Work with Learning and Development to provide training and educational programs to staff and stakeholders on compliance requirements, standards, and best practices.
Regularly assess the organization’s activities, data, and operations to identify areas of non-compliance or potential risks.
Prepare and submit compliance reports to the Medicare Compliance Officer, senior management, and relevant regulatory bodies as required. Communicate findings and make recommendations for corrective actions.
Lead or assist in internal investigations related to compliance issues, including Duals-specific concerns. Collaborate with legal and HR teams when necessary.
Analyze data to identify trends and patterns related to compliance. Use data to proactively address potential issues.