Healthcare Director Medicare Compliance

6 days ago


New York, New York, United States MetroPlusHealth Full time
About the Job: We are seeking a skilled Medicare Compliance Specialist to join our team at MetroPlus Health. In this role, you will serve as the subject matter expert and resource for all departments and intergovernmental, federal regulatory agencies related to various Medicare products and operations to ensure compliance. With a strong background in Medicare management, operations, and/or federal and state regulatory compliance experience, you will be responsible for providing a resource to all operational departments regarding the Medicare management, communicating any changes to Medicare management to all departments, and ensuring that all applicable Medicare regulatory requirements are met.

As a seasoned professional in the healthcare industry, you will have a deep understanding of Medicare Special Needs programs, including operational and regulatory requirements around Medicare Special Needs programs e.g., HIV. You will work closely with the Regulatory Affairs Department to implement state and federally mandated program changes, assist with new program development and communications, and review and approve marketing, member and provider-related materials. Additionally, you will be responsible for annual Medicare Bid submission, performing root cause analysis of identified issues, and providing oversight of plan & vendor operations as they relate to the Medicare line of business. Your expertise will also be utilized to participate in medical cost discussions, evaluate programs to maximize revenue and decrease costs, and attend provider sessions dealing with Medicare issues.

If you are a results-driven individual with a passion for delivering high-quality healthcare services, we encourage you to apply for this exciting opportunity. The estimated salary for this role is $110,000 - $160,000 per year.

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