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Commonwealth Care Alliance Sr. Manager, Medicare Compliance - Remote in Boston, Massachusetts

Why This Role is Important to Us:

Under direction of the Director of Medicare Compliance, the primary focus areas of this position include development and oversight of the regulatory coompliance program. This includes: Corrective Action Plan (CAP) management, regulatory reporting to Centers for Medicare & Medicaid Services (CMS), State Agencies and Department of Insurance (DOI), oversight of the distribution and tracking of regulatory memos to the organization and marketing review.

Supervision Exercised:

Yes, which includes but is not limited to providing leadership, work direction, and performance feedback to subordinate staff.

What You'll Be Doing:

Essential Duties & Responsibilities:

System Administrator for GRC System

  • System Administrator for GRC System

  • Develop reports within the system for distribution among the organization

  • Identify and scope needed system enhancements

  • Work with vendor to correct identified issues

  • Oversee the development and maintenance of system process documentation

  • Work with training specialist to develop user tools

  • Become subject matter expert for entire GRC system

Oversight of CCA’s Regulatory Reporting Program

  • Act as primary contact for regulatory reporting submissions

  • Distribute requests to staff as needed

  • Review reports to ensure accuracy

  • Develop and maintain training and requirements documentation and instructions and provide training as required

  • Support business units in interpretation of regulations related to their applicable areas as well as aid in developing appropriate tools to ensure compliance

Manage staff who will:

  • Submit reports to regulators

  • Submit materials to regulators

  • Coordinate attestations from Senior Leadership for submission

Compliance Regulatory Guidance Distribution

  • Monitor and distribute regulatory memos such as State memos, HPMS memos, Final Rules and other regulatory guidance released from governing bodies to the business

  • Track action items resulting from regulatory memos to ensure timely completion

  • Provide guidance to the organization on interpretation of regulatory guidance

  • Create trainings as needed to implement new requirements

Working Conditions:

Standard office conditions.

What We're Looking For:

Qualifications:

  • Bachelor's Degree or equivalent experience required,Master’s degree in health care administration, public administration, public health, or business administration preferred.

  • HCCA Certified in Healthcare Compliance (CHC) preferred.

  • 5 or more years direct work experience in regulatory affairs and/or compliance in Medicare or Medicaid required

  • 5 or more years of managerial experience required

  • Health care industry experience required.

  • Project management skills or equivalent required

Required Knowledge, Skills & Abilities (must have):

  • Strong written, verbal, listening andcommunication skills – having the ability to understand and communicate appropriately to the targeted audience

  • Strong supervisory/managerial skills.

  • Manage staff workload appropriately and identify areas of improvement and areas for professional development for staff

  • Strong analytical skills – having the abilityto identify an issue, conduct an analysis to determine business impact (including gap analyses), troubleshoot

  • Strong project management skills - havingthe ability to effectively manage multiple priorities simultaneously by maintaining established timeframes, adhering to work plans, and communicating changes effectively

  • Strategic thinking and planning in order tocontinue to enhance the Compliance Program and the role of compliance within the organization; ability to initiate and develop new solutions to problems, to identify new opportunities; and have organizational perspective to see how the pieces fit and reflect that perspective in day-to-day decisions

  • Ability to influence team members andowners to resolve issues in atimely manner

  • Requires diplomatic and negotiation skillsand understanding of needs of internal and external partners

  • Ability to work independently

  • Ability to present information clearly inmeetings and to communicate with team members and senior leadership

  • Requires excellent interpersonal skills inorder to communicate and work with staff of all skill and experience levels

  • Self-directed with proven initiation skills

  • Must be able to effectively communicatewith colleagues, internal customers, and vendors

Required Language (must have):

  • English

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.

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