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Director, Medicare Compliance
3 months ago
Director, Medicare Compliance - Remote
Boston ,
Massachusetts
Apply Now
The Director of Regulatory Compliance works directly with the Vice President Health Plan Regulatory Compliance/National Medicare Compliance Officer to develop and maintain an effective Health Plan Regulatory Compliance Program.
This position is responsible for leading the development, implementation, and ongoing maintenance of elements of an effective Compliance Program, including Regulatory and Contractual Compliance for each CCA Program; GRC system implementation; Compliance Auditing and Monitoring programs.
This position is also responsible for the oversight of all regulatory and contractual requirements related to each CCA Program; and disseminating requirements to appropriate internal staff.
The Director of Regulatory Compliance is accountable to strengthen internal controls, educational requirements, reporting, and complaint mechanisms, proactive monitoring and mitigation of risk, and compliance expectations of all personnel and FDRs supporting business operations.
This position plays a strategic role in shaping the overall Compliance infrastructure at Commonwealth Care Alliance (CCA).Supervision Exercised:
Yes,which includes but is not limited to providing leadership, work direction, and performance feedback to subordinate staff.
What You'll Be Doing:
Health Plan Regulatory Compliance Program
Ensure Regulatory Compliance Program Description and Policies are reviewed and updated on a regular basis
Develop and implement methods and programs that encourage managers, employees, and FDRs to report program noncompliance without fear of retaliation
Maintain and/or have access to applicable compliance reporting mechanism and closely coordinating with the Internal Audit Department and the FWA/SIU functions
In conjunction with the VP Regulatory Compliance, participates in the development, implementation, and facilitation of strategies for all compliance related activities
Participate in investigations of reported compliance concerns, developing recommendations for appropriation corrective action
Oversee monitoring/auditing function for health plan regulatory compliance operational business units
Oversight of CCA's Compliance Research Program
Work collaboratively with management, workforce, and contractors to ensure program-wide compliance efforts are and remain in alignment with CCA's Code of Conduct with business operations, and with federal, state, and local requirements
Provide regular reports to compliance leadership, SLT/ELT, internal Compliance Committee, Audit
Oversight of Regulatory and Contractual Reporting
Ensure an accurate and complete inventory of regulatory and contractual reporting requirements is maintained
Work directly with Regulators to resolve any questions or discrepancies in reports as needed
Develop processes and workflows to promote accurate and timely reporting submissions
Continuously monitor the Reporting program to identify needed enhancements
Work directly with CCA leadership to resolve any ownership and/or data issues related to reporting
Oversee the development of metrics and reporting to demonstrate effectiveness of CCA's compliance program
Ensure metrics are reported regularly and updated as needed to demonstrate effectiveness
Provide mechanism for escalation when metrics begin to show issues with operational efficiency
Identify, prioritize and scope needed system enhancements
Compliance Program Metrics
Oversee and manage processes that generate Compliance data to ensure it meets all requirements for applicable laws and regulations that govern the industry
Oversee the development of metrics and reporting to demonstrate effectiveness of CCA's compliance program
Ensure metrics are reported regularly and updated as needed to demonstrate effectiveness
Provide mechanism for escalation when metrics begin to show issues with operational efficiency
Identify, prioritize and scope needed system enhancements
Support Overall Compliance Infrastructure
Work collaboratively with the VP Medicare Compliance on strategic department planning including budget development, staff resource allocation and shaping the overall Regulatory Affairs Compliance infrastructure.
Promote compliance in CCA's business operations with all Medicare and Medicaid contractual and regulatory requirements.Develop, implement, and maintain a system to monitor and track day to day compliance activities across the organization.
Serve as Regulatory Affairs and Compliance liaison with key internal departments
Provide guidance and assistance as requested
Hold meetings with department leadership at agreed upon intervals
Attend department staff meetings and present information as requested
Assist in development of regulatory toolkits and instruction materials as needed to assist departments with regulatory projects and process implementation
Support business units in interpretation of regulations related to their applicable areas as well as provide assistance in developing appropriate tools to ensure compliance
Provide consultation with business owners in developing policies and procedures and/or building internal workflows to ensure internal controls of high-risk regulatory requirements are in place and working effectively
Project manage multiple organization-wide initiatives that occur on an annual or on an ad hoc basis.
Working Conditions:
Standard office conditions.
What We're Looking For:
Qualifications:
Bachelor's degree is required, Master's degree in health care administration, public administration, public health, or business administration is preferred.
Certified Healthcare Compliance (CHC) preferred
7 or more years direct work experience in regulatory affairs and/or compliance required
7 or more years of managerial experience is required.
Health care industry experience required.
Project management skills or equivalent are required.
Strong written, verbal, listening and communication skills having the ability to understand and communicate appropriately to the targeted audience
Strong supervisory/managerial skills. Manage staff workload appropriately andidentify areas of improvement and areas for professional development for staff
Strong analytical skills having the ability to identify an issue, conduct an analysis to determine business impact (including gap analyses), troubleshoot
Strong project management skills - having the ability to effectively manage multiple priorities simultaneously by maintaining established timeframes, adhering to work plans, and communicating changes effectively
Strategic thinking and planning to continue to enhance the Compliance Program and the role of compliance within the organization: ability to initiate and develop new solutions to problems, to identify new opportunities; and have organizational perspective to see how thepieces fit and reflect that perspective inday-to-day decisions
Ability to influence team members and owners to resolve issues in a timely manner
Requires diplomatic and negotiation skills and understanding of needs of internal and external partners
Ability to work independently
Ability to present information clearly in meetings and to communicate with team members and senior leadership
Requires excellent interpersonal skills in order to communicate and work with staff of all skill and experience levels
Self-directed with proven initiation skills
Must be able to effectively communicate with colleagues, internal customers, and vendors
Required Language(s):
Required Other:
Position requires constant operation of a computer and other office equipment (i.e., copy machine, Polycom equipment, and computer printer)
Must be able to remain in a stationary position 50 percent of the time
EEO is The Law
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable).
Commonwealth Care Alliance is an equal opportunity employer.Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.
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