Medicare Compliance Program Manager

Mass General Brigham Health Plan
United States, Massachusetts, Somerville
399 Revolution Drive (Show on map)
Feb 26, 2025
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 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. 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%) 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.