What are the responsibilities and job description for the Medicare Compliance Program Manager position at Mass General Brigham?
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.
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 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.
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
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
Physical Requirements
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. 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.
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.
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 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.
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.
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
- 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.
Physical Requirements
- Standing Occasionally (3-33%)
- Walking Occasionally (3-33%)
- Sitting Constantly (67-100%)
- Lifting Occasionally (3-33%) 20lbs - 35lbs
- Carrying Occasionally (3-33%) 20lbs - 35lbs
- Pushing Rarely (Less than 2%)
- Pulling Rarely (Less than 2%)
- Climbing Rarely (Less than 2%)
- Balancing Occasionally (3-33%)
- Stooping Occasionally (3-33%)
- Kneeling Rarely (Less than 2%)
- Crouching Rarely (Less than 2%)
- Crawling Rarely (Less than 2%)
- Reaching Occasionally (3-33%)
- Gross Manipulation (Handling) Constantly (67-100%)
- Fine Manipulation (Fingering) Frequently (34-66%)
- Feeling Constantly (67-100%)
- Foot Use Rarely (Less than 2%)
- Vision - Far Constantly (67-100%)
- Vision - Near Constantly (67-100%)
- Talking Constantly (67-100%)
- Hearing Constantly (67-100%)
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. 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.
