Medicare Compliance Program Manager

At Mass General Brigham, we know it takes a surprising range of talented professionals to advance our mission-from doctors, nurses, business people and tech experts, to dedicated researchers and systems analysts. As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve.

At Mass General Brigham, we believe a diverse set of backgrounds and lived experiences makes us stronger by challenging our assumptions with new perspectives that can drive revolutionary discoveries in medical innovations in research and patient care. Therefore, we invite and welcome applicants from traditionally underrepresented groups in healthcare – people of color, people with disabilities, LGBTQ community, and/or gender expansive, first and second-generation immigrants, veterans, and people from different socioeconomic backgrounds – to apply.

This is a hybrid role that requires an onsite presence in the office 1x/month.

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

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on 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 consciously inclusive environment where diversity is celebrated.

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

Job Summary

Responsible for leading and overseeing the development, implementation, and monitoring of the hospital’s Medicare compliance program. This role involves ensuring adherence to regulatory requirements, mitigating risks, and fostering a culture of compliance within the organization.

Does this position require Patient Care?
No

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 hospital 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 Related Field of Study required or Bachelor’s Degree Legal Studies required or Master’s Degree Related Field of Study preferred

Can this role accept experience in lieu of a degree?
No

Experience

• At least 5-7 experience in healthcare compliance, with a focus on Medicare 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)

Physical Requirements

Remote Type

Hybrid

Work Location

399 Revolution Drive

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Day (United States of America)

EEO Statement:

Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. 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.

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.

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