Senior Manager, Compliance Program

Point32Health • Canton, MA

2d • $136,219 - $204,329

About The Position

The Senior Manager, Compliance Program will manage the day-to-day operations of the compliance function of Point32Health’s Government Programs Compliance Program. This includes identifying and having a detailed knowledge of compliance requirements; identifying compliance risks; and direct administration of activities, projects, and personnel necessary to ensure compliance with Medicare, Commercial and Medicaid laws and regulations and governing contracts with the Centers for Medicare and Medicaid Services (CMS) and, as applicable, State Agencies.The Senior Manager, Compliance Program will report to the Government Programs Compliance Officer. This position supporting the Chief Compliance and Ethics Officer and the Government Programs Compliance Officer and working collaboratively as a member of the compliance leadership team.

Requirements

• 10-12 years of directly related experience in personnel management and compliance related activities, legislative and regulatory activities, health insurance operations or legal research or equivalent combination of education and experience.
• 5+ years of Medicare and/or Medicaid Compliance experience.
• Strong experience with Medicare and/or Medicaid health care products.
• Demonstrated knowledge of government regulations as they relate to the administration of Medicare and/or Medicaid healthcare programs, principles, and practices of managed care.
• Project coordination and management experience.
• Ability to influence others at all levels across the organization without direct reporting authority
• Strong research, writing, public speaking, and computer skills
• Understanding of health policy issues related to medical and other healthcare activities.
• Strong subject matter expertise in Medicare and/or Medicaid Operations and Compliance Requirements
• Demonstrated effectiveness operating in complex organizational environments.
• Excellent written, oral, and presentation communication skills.
• Proven ability to work with all levels of management.
• Strong problem-solving skills.
• Demonstrated ability to partner effectively with others in the handling complex issues
• Strong leadership skills with ability to lead cross functional teams
• Ability to develop and support staff in their professional development
• Must be able to work under normal office conditions and work from home as required.
• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
• May be required to work additional hours beyond standard work schedule.

Nice To Haves

• JD or Master’s Degree in health care administration, public administration or related field
• Sense of Humor

Responsibilities

• Provide leadership for execution on a strategy for sustaining compliance with applicable federal and state laws and regulations in the Government Programs Compliance Program that is effective and efficient, including leading people and processes and building a culture of integrity.
• In consultation with the Government Programs Compliance Officer, responsible for managing, documenting, and maintaining a coordinated regulatory compliance infrastructure that meets the expectations of State Medicaid and/or Federal Medicare regulators and corporate governance programs.
• Ensure a high-standing relationship with CMS/EOHHS regulators in support of Point32Health’s government products and meet the expectations and requirements of internal and external customers.
• Serve as primary liaison between CMS/EOHHS and Point32Health to respond to CMS/EOHHS concerns and to advance Point32Health’s business and regulatory priorities.
• Coordinate external and internal monitoring reviews.
• Develop and implement program policies, procedures and practices designed to promote compliance with the requirements of State and Federal health care programs and that implement components of the compliance program.
• Work autonomously with the Senior Leadership team and department heads to increase awareness of the importance of the Compliance Program and develop and maintain positive relationships between compliance and operations personnel.
• Attend operations staff meetings for functions with significant impact on compliance.
• Work with the Senior Leadership team and department heads to provide adequate information to ensure that they and their employees have the requisite information and knowledge of regulatory issues and requirements to carry out their responsibilities in a lawful and ethical manner.
• Manage the compliance unit’s administrative duties, including organizing and maintaining relevant documents; preparing necessary reports on activities; and directing and supervising staff, including administering performance evaluations and disciplinary action as needed.
• Monitor compliance performance by operational areas.
• Undertake investigations of compliance inquiries, prepare reports, and monitor remediation.
• Develop external contacts to position the Company as a leader in health care compliance programs.
• Lead annual and ongoing risk assessment processes and develop associated risk assessment reporting;
• Develop and maintain program and procedures for vendor (FDR and Material Subcontractor) oversight.
• With the Audit and Monitoring unit of the Compliance Department, develop audit, monitoring, and compliance work plans and oversee their implementation.
• Monitor and report on the effectiveness of corrective action plans.
• Collaborate with the Fraud special investigations unit to ensure program meets CMS requirements.
• Provide updates and reports to Compliance Steering Committee as needed.
• Participate as a member of the compliance leadership group.
• Other projects and duties as assigned.

Benefits

• Medical, dental and vision coverage
• Retirement plans
• Paid time off
• Employer-paid life and disability insurance with additional buy-up coverage options
• Tuition program
• Well-being benefits
• Full suite of benefits to support career development, individual & family health, and financial health

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Number of Employees: 1,001-5,000 employees