Senior Manager, Compliance Program

Who We Are

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work. 

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health.

Job Summary

The Senior Manager, Compliance Program will manage the day-to-day operations of the compliance function of Point32Health’s Government Programs Compliance Program. This includes identifying and having a detailed knowledge of compliance requirements; identifying compliance risks; and direct administration of activities, projects, and personnel necessary to ensure compliance with Medicare, Commercial and Medicaid laws and regulations and governing contracts with the Centers for Medicare and Medicaid Services (CMS) and, as applicable, State Agencies.The Senior Manager, Compliance Program will report to the Government Programs Compliance Officer. This position supporting the Chief Compliance and Ethics Officer and the Government Programs Compliance Officer and working collaboratively as a member of the compliance leadership team.

Job Description

Key Responsibilities/Duties – what you will be doing (top five):

• Provide leadership for execution on a strategy for sustaining compliance with applicable federal and state laws and regulations in the Government Programs Compliance Program that is effective and efficient, including leading people and processes and building a culture of integrity.
• In consultation with the Government Programs Compliance Officer, responsible for managing, documenting, and maintaining a coordinated regulatory compliance infrastructure that meets the expectations of State Medicaid and/or Federal Medicare regulators and corporate governance programs.
• Ensure a high-standing relationship with CMS/EOHHS regulators in support of Point32Health’s government products and meet the expectations and requirements of internal and external customers. Serve as primary liaison between CMS/EOHHS and Point32Health to respond to CMS/EOHHS concerns and to advance Point32Health’s business and regulatory priorities.
• Coordinate external and internal monitoring reviews.
• Develop and implement program policies, procedures and practices designed to promote compliance with the requirements of State and Federal health care programs and that implement components of the compliance program.
• Work autonomously with the Senior Leadership team and department heads to increase awareness of the importance of the Compliance Program and develop and maintain positive relationships between compliance and operations personnel. Attend operations staff meetings for functions with significant impact on compliance.
• Work with the Senior Leadership team and department heads to provide adequate information to ensure that they and their employees have the requisite information and knowledge of regulatory issues and requirements to carry out their responsibilities in a lawful and ethical manner.
• Manage the compliance unit’s administrative duties, including organizing and maintaining relevant documents; preparing necessary reports on activities; and directing and supervising staff, including administering performance evaluations and disciplinary action as needed.
• Monitor compliance performance by operational areas.
• Undertake investigations of compliance inquiries, prepare reports, and monitor remediation.
• Develop external contacts to position the Company as a leader in health care compliance programs.
• Lead annual and ongoing risk assessment processes and develop associated risk assessment reporting;
• Develop and maintain program and procedures for vendor (FDR and Material Subcontractor) oversight.
• With the Audit and Monitoring unit of the Compliance Department, develop audit, monitoring, and compliance work plans and oversee their implementation.
• Monitor and report on the effectiveness of corrective action plans.
• Collaborate with the Fraud special investigations unit to ensure program meets CMS requirements.
• Provide updates and reports to Compliance Steering Committee as needed.
• Participate as a member of the compliance leadership group.
• Other projects and duties as assigned.

Qualifications – what you need to perform the job

Certification and Licensure

Education

• Required (minimum): Bachelor’s Degree in degree in health care administration, public administration or related field
• Preferred: JD or Master’s Degree in health care administration, public administration or related field

Experience

• Required (minimum): 10-12 years of directly related experience in personnel management and compliance related activities, legislative and regulatory activities, health insurance operations or legal research or equivalent combination of education and experience. 5+ years of Medicare and/or Medicaid Compliance experience. Strong experience with Medicare and/or Medicaid health care products. Demonstrated knowledge of government regulations as they relate to the administration of Medicare and/or Medicaid healthcare programs, principles, and practices of managed care. Project coordination and management experience.
• Preferred:

Skill Requirements

• Ability to influence others at all levels across the organization without direct reporting authority
• Strong research, writing, public speaking, and computer skills
• Understanding of health policy issues related to medical and other healthcare activities.
• Strong subject matter expertise in Medicare and/or Medicaid Operations and Compliance Requirements
• Demonstrated effectiveness operating in complex organizational environments.
• Excellent written, oral, and presentation communication skills.
• Proven ability to work with all levels of management.
• Strong problem-solving skills.
• Demonstrated ability to partner effectively with others in the handling complex issues
• Strong leadership skills with ability to lead cross functional teams
• Ability to develop and support staff in their professional development
• Sense of Humor

Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):

• Must be able to work under normal office conditions and work from home as required.
• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
• May be required to work additional hours beyond standard work schedule.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

Salary Range

$136,219.20 -$204,328.80

Compensation & Total Rewards Overview

The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization.  The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.

Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

• Medical, dental and vision coverage

• Retirement plans

• Paid time off

• Employer-paid life and disability insurance with additional buy-up coverage options

• Tuition program

• Well-being benefits

• Full suite of benefits to support career development, individual & family health, and financial health

For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/

We welcome all
All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Scam Alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact [email protected]