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Medicare Compliance Oversight Manager
2 months ago
My Senior Health Plan is seeking a dedicated professional with extensive experience in Medicare Compliance, particularly with the Centers for Medicare & Medicaid Services (CMS).
This role is full-time and onsite. Candidates must be local to the area. A hybrid work arrangement may be considered after the initial training period based on performance.
About Us: We are a direct-to-consumer insurance brokerage that specializes in Medicare. Our mission is to provide transparent and unbiased insurance comparisons, representing leading insurance carriers. Our focus on Senior Health Insurance ensures we stay informed about the latest products, technologies, and industry news.
Position Summary: The Medicare Insurance Compliance Manager will operate from our new office and will be responsible for overseeing compliance with all CMS and state regulatory requirements, as well as internal policies and procedures. This role includes developing, conducting, coordinating, and reporting on audit and investigative activities aimed at preventing and detecting fraud, abuse, and waste.
Key Responsibilities:
- Ensure compliance with all CMS, Medicare Advantage, Part D, and DSNP regulatory requirements.
- Act as a subject-matter expert on compliance topics, maintaining comprehensive knowledge of relevant laws and regulations.
- Monitor and report on Compliance Program metrics.
- Develop and implement compliance strategies, programs, and goals.
- Stay updated on industry developments and changes in health insurance regulations.
- Work collaboratively with leadership to ensure internal controls are effective for compliance.
- Participate in risk assessment tool development and create tailored audit plans.
- Identify and address compliance issues and opportunities for improvement.
- Coordinate responses to compliance inquiries and investigations.
- Draft and update Compliance Program policies.
- Provide training and guidance to staff on CMS and Carrier regulations.
- Manage various compliance-related projects and audits.
- Assist with regulatory filings and documentation as required.
- Perform additional duties as assigned.
Qualifications:
- 3-5 years of experience in insurance compliance, specifically in Medicare and Medicaid regulations.
- Strong analytical and problem-solving skills.
- Excellent communication and interpersonal abilities.
- Knowledge of healthcare industry operations and provider credentialing processes.
- Ability to manage multiple projects effectively.
Benefits:
- Competitive salary and performance-based bonuses.
- Comprehensive health insurance including Medical, Dental, Life, and Vision.
- 401k matching and profit-sharing opportunities.
- Paid sick leave and vacation time.
- Positive work environment and corporate wellness programs.
Equal Opportunity Employer: My Senior Health Plan is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability, or any other characteristic protected by applicable law.
