Compliance Services Manager

JOB SUMMARY:

This role will focus on Risk Adjustment Management (RAM) oversight, ensuring adherence to compliance standards, supporting call center operations, and providing strategic guidance and service to field teams. The ideal candidate will have strong leadership skills, a solid understanding of Medicare Advantage regulations, and experience in managing cross-functional compliance initiatives.

ESSENTIAL JOB DUTIES:

To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.

• Lead the development, implementation, and monitoring of compliance strategies related to RAM processes.
• Ensure adherence to CMS (Centers for Medicare & Medicaid Services) guidelines and mitigate compliance risks.
• Collaborate with stakeholders to evaluate and enhance RAM policies and procedures.
• Monitor audit findings and implement corrective actions as necessary.
• Oversee the compliance operations within the call center, ensuring alignment with internal policies and external regulatory requirements.
• Develop and maintain training programs to reinforce CMS-compliant communication practices.
• Conduct periodic audits and reviews of call center interactions to identify areas for improvement
• Respond promptly to compliance-related escalations or issues from call center operations.
• Act as a compliance liaison to field teams, providing training, resources, and advisory support to uphold regulatory standards.
• Assist in the resolution of compliance issues that arise during field operations.
• Develop strategies to support field teams in maintaining accurate and timely reporting related to Medicare Advantage programs.
• Collaborate with field leadership to ensure consistent messaging and compliance practices across regions.
• Stay current on changes to Medicare Advantage regulations, guidelines, and industry trends.
• Prepare and present compliance reports to senior management and relevant committees.
• Proactively identify risks, propose mitigation strategies, and ensure compliance activities meet deadlines.
• Partner with legal, operations, quality, and other departments to drive compliance initiatives.
• Coordinate with external auditors and regulatory bodies during reviews and audits.
• Champion a culture of compliance through education, advocacy, and strong communication.
• Other duties as assigned.

JOB REQUIREMENTS:

• Regular and reliable attendance
• Meet productivity standards
• Successfully complete required training
• Handle multiple priorities effectively
• Independent discretion/decision making
• Make decisions under pressure

Required Computer Software/Equipment Used:

• Various operating systems
• Standard office equipment
• Microsoft Suite applications
• Desktop, laptop and/or iPad

EQUAL OPPORTUNITY EMPLOYER

This Organization is an equal opportunity employer. We do not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. This Organization will make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. A key part of this policy is to provide equal employment opportunity regarding all terms and conditions of employment and in all aspects of a person's relationship with the Organization including recruitment, hiring, promotions, upgrading positions, conditions of employment, compensation, training, benefits, transfers, discipline, and termination of employment.

I have reviewed this job description. I understand my job duties and responsibilities prior to signing this form. Additionally, I understand that I should seek immediate clarification from my direct supervisor should I have any questions regarding the responsibilities outlined herein. I certify that I can perform the essential functions and attest that I possess the qualifications as outlined. Furthermore, I understand future performance evaluations are based on my ability to perform the duties and responsibilities outlined in this job description to the satisfaction of my immediate supervisor.