Compliance Director for Medicare Operations

5 days ago


Worcester, Massachusetts, United States Central Mass Health LLC Full time
Job Overview

We are seeking a seasoned Compliance Director to oversee our Medicare operations, ensuring seamless compliance with federal regulations.

About Us

Central Mass Health LLC is a leading health care provider in Worcester, MA, affiliated with the largest health care system in Central Massachusetts, UMass Memorial Health.

Responsibilities
  • Develop and implement an annual compliance program schedule
  • Collaborate with internal departments and external vendors on compliance activities and programs
  • Design and deliver compliance training programs for employees, sales staff, and contractors
  • Update compliance policies and procedures to ensure adherence to Federal regulations
  • Manage HPMS submissions, CMS audits, and corrective action plans
  • Ensure compliance with program requirements and regulations governing service area expansions and Plan Benefit Packages
Requirements
  • Bachelor's degree in Health Care Administration or related field; Master's degree preferred
  • A minimum of four years' experience in regulatory agency compliance; five years with Medicare Managed Care programs required
  • Knowledge of CMS and Medicare Advantage Prescription Drug Plans; Health Care Compliance Certification a plus

$120,000 - $150,000 per year, depending on experience.



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