Senior Medicare Compliance Program Manager

Mass General Brigham • Somerville, MA

21h • 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 Senior Medicare Compliance Program Manager is a key member of the Legal, Regulatory Affairs, and Compliance team to support the organization's Medicare Advantage line of business. This position will report directly to the Senior Director of Medicare Regulatory Compliance and take the lead on managing Medicare Advantage compliance and regulations. This position will provide complex project/program management related to risk, regulations, and audits on this line of business. The Senior Medicare Compliance Program Manager will be a member of the Medicare Advantage cross-functional project team, and their role will be to ensure compliance, help to identify and mitigate risks of noncompliance, and provide regulatory requirements and guidance on how to implement, operationalize, and optimize. The Senior Medicare Compliance Program Manager is responsible for managing all of the key compliance initiatives, integration/optimization of business functions, and supporting the Medicare Advantage line of business. This person will do so by performing risk assessments and analysis to support proactive and reactive mitigation recommendations.

Requirements

• Bachelor's Degree required; Master's Degree preferred
• At least 5-7 years of experience in health plan compliance, with a focus on Medicare (Medicare Advantage and/or DSNP) regulations required
• In-depth knowledge of Medicare rules, guidelines, and compliance expectations.
• Strong understanding of healthcare laws and regulations.
• Excellent communication and interpersonal skills.
• Proven experience in developing and implementing compliance programs.
• Detail-oriented with strong analytical and problem-solving skills.

Responsibilities

• Develop and implement MGB Health Plan's Medicare compliance program, including policies, procedures, and guidelines.
• Conduct regular risk assessments related to Medicare compliance.
• Identify potential areas of non-compliance and implement strategies to mitigate risks.
• Collaborate with various health plan departments to ensure integration of compliance requirements into their processes.
• Conduct investigations into potential compliance violations related to Medicare.
• Prepare and submit required reports to regulatory bodies and authorities as necessary.
• Review and update Medicare compliance policies and procedures regularly.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level