Site: Mass General Brigham Health Plan Holding Company, Inc.

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.

We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.

The Senior Medicare Compliance Program Manager is a key member of the Legal, Regulatory Affairs, and Compliance team to support the organization's Medicare Advantage line of business. This position will report directly to the Senior Director of Medicare Regulatory Compliance and take the lead on managing Medicare Advantage compliance and regulations. This position will provide complex project/program management related to risk, regulations, and audits on this line of business. The Senior Medicare Compliance Program Manager will be a member of the Medicare Advantage cross-functional project team, and their role will be to ensure compliance, help to identify and mitigate risks of noncompliance, and provide regulatory requirements and guidance on how to implement, operationalize, and optimize.

The Senior Medicare Compliance Program Manager is responsible for managing all of the key compliance initiatives, integration/optimization of business functions, and supporting the Medicare Advantage line of business. This person will do so by performing risk assessments and analysis to support proactive and reactive mitigation recommendations.

Job Summary:

Responsible for leading and overseeing the development, implementation, and monitoring of the MGB Health Plan's Medicare compliance program. This role involves ensuring adherence to regulatory requirements, mitigating risks, and fostering a culture of compliance within the organization.
Essential Functions
-Develop and implement MGB Health Plan's Medicare compliance program, including policies, procedures, and guidelines.
-Conduct regular risk assessments related to Medicare compliance.
-Identify potential areas of non-compliance and implement strategies to mitigate risks.
-Collaborate with various health plan departments to ensure integration of compliance requirements into their processes.
-Conduct investigations into potential compliance violations related to Medicare.
-Prepare and submit required reports to regulatory bodies and authorities as necessary.
-Review and update Medicare compliance policies and procedures regularly.

Qualifications:

Education

• Bachelor's Degree required; Master's Degree preferred

Experience

• At least 5-7 years of experience in health plan compliance, with a focus on Medicare (Medicare Advantage and/or DSNP) regulations required

Knowledge, Skills, and Abilities

• In-depth knowledge of Medicare rules, guidelines, and compliance expectations.
• Strong understanding of healthcare laws and regulations.
• Excellent communication and interpersonal skills.
• Proven experience in developing and implementing compliance programs.
• Detail-oriented with strong analytical and problem-solving skills.

Additional Job Details (if applicable)

Working Conditions:

• This is a hybrid role that requires an on-site presence at the office in Assembly Row, Somerville roughly 2- 3x/month

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Remote Type

Hybrid

Work Location

399 Revolution Drive

Scheduled Weekly Hours:

40

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$99,465.60 - $141,804.00/Annual

Grade

8

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

EEO Statement:

8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.