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Medicare Compliance Oversight Manager

2 months ago

Brentwood, Tennessee, United States My Senior Health Plan Full time
Job Overview

My Senior Health Plan is actively seeking a qualified individual with extensive experience in Medicare Compliance, particularly with the Centers for Medicare & Medicaid Services (CMS).

This role is a full-time onsite position. Candidates must be local to the area. A hybrid work arrangement may be considered after the initial training period based on performance and proficiency.

As a leading insurance brokerage focused on Medicare, we pride ourselves on delivering transparent and unbiased insurance comparisons. Our specialization in Senior Health Insurance allows us to stay informed about the latest products, technologies, and developments in the industry.

The successful candidate will possess a thorough understanding of healthcare regulations and laws, along with the ability to analyze and interpret relevant data effectively. Strong communication skills and the ability to collaborate with various stakeholders to ensure compliance with applicable regulations are essential.

Key Qualifications:

  • A minimum of 3-5 years of experience in insurance compliance, specifically in Medicare and Medicaid regulations.
  • In-depth knowledge of the healthcare sector and familiarity with provider credentialing processes.
  • Ability to manage multiple projects concurrently, demonstrating strong problem-solving and analytical capabilities.
  • Highly organized with excellent interpersonal and communication skills.

Position Summary:

Reporting to the President/CEO and the Business Operations Officer, the Medicare Compliance Manager will oversee adherence to all CMS and state regulatory requirements, contract stipulations, and company policies. This role includes developing, conducting, coordinating, and reporting on audit and investigative activities aimed at preventing and detecting fraud, abuse, and waste.

Core Responsibilities:

  • Develop and monitor compliance with CMS, Medicare Advantage, Part D, and DSNP regulatory requirements in alignment with state and federal laws.
  • Lead compliance strategies, programs, and objectives.
  • Stay updated on industry changes and health insurance regulations.
  • Understand the requirements for effective compliance programs as outlined in OIG Guidance and Federal Sentencing Guidelines.
  • Collaborate with leadership to ensure adequate internal controls for compliance.
  • Participate in creating risk assessment tools and a tailored audit plan for each business unit.
  • Identify and address compliance issues while enhancing organizational compliance.
  • Coordinate responses to compliance inquiries and investigations.
  • Draft, update, and implement Compliance Program policies.
  • Provide training and guidance to staff on CMS and Carrier regulations.
  • Manage projects, regulatory audits, internal audits, and risk assessments.
  • Assist with the submission of necessary regulatory documents and reports.
  • Perform additional duties as assigned.

Supervisory Responsibilities:

None

Reporting Structure:

Reports to the Business Operations Manager and President/CEO.

Benefits:

  • Competitive salary and performance-based bonuses.
  • Health insurance, including Medical, Dental, Life, and Vision coverage.
  • 401k matching and profit-sharing opportunities.
  • Paid sick leave and vacation time.
  • Paid holidays and a positive work environment.
  • Corporate wellness program with gym membership discounts.

Application Information:

My Senior Health Plan is an Equal Opportunity/Affirmative Action 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 law.

All employment offers are contingent upon passing a pre-employment drug test and background check.

My Senior Health Plan participates in E-Verify.

Job Type: Full-time

Work Location: In-office