Commonwealth Care Alliance
Sr. Manager, Medicare Compliance - Remote
Commonwealth Care Alliance, Boston, Massachusetts, us, 02298
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 compliance 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 SystemSystem Administrator for GRC SystemDevelop reports within the system for distribution among the organizationIdentify and scope needed system enhancementsWork with vendor to correct identified issuesOversee the development and maintenance of system process documentationWork with training specialist to develop user toolsBecome subject matter expert for entire GRC systemOversight of CCA's Regulatory Reporting ProgramAct as primary contact for regulatory reporting submissionsDistribute requests to staff as neededReview reports to ensure accuracyDevelop and maintain training and requirements documentation and instructions and provide training as requiredSupport business units in interpretation of regulations related to their applicable areas as well as aid in developing appropriate tools to ensure complianceManage staff who will:Submit reports to regulatorsSubmit materials to regulatorsCoordinate attestations from Senior Leadership for submissionCompliance Regulatory Guidance DistributionMonitor and distribute regulatory memos such as State memos, HPMS memos, Final Rules and other regulatory guidance released from governing bodies to the businessTrack action items resulting from regulatory memos to ensure timely completionProvide guidance to the organization on interpretation of regulatory guidanceCreate trainings as needed to implement new requirementsWorking 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 and communication 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 ability to identify an issue, conduct an analysis to determine business impact (including gap analyses), troubleshoot.Strong project management skills - having the 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 to continue 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 and owners to resolve issues in a timely manner.Requires diplomatic and negotiation skills and understanding of needs of internal and external partners.Ability to work independently.Ability to present information clearly in meetings and to communicate with team members and senior leadership.Requires excellent interpersonal skills in order to communicate and work with staff of all skill and experience levels.Self-directed with proven initiation skills.Must be able to effectively communicate with colleagues, internal customers, and vendors.Required Language (must have):English
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What You'll Be Doing:Essential Duties & Responsibilities:System Administrator for GRC SystemSystem Administrator for GRC SystemDevelop reports within the system for distribution among the organizationIdentify and scope needed system enhancementsWork with vendor to correct identified issuesOversee the development and maintenance of system process documentationWork with training specialist to develop user toolsBecome subject matter expert for entire GRC systemOversight of CCA's Regulatory Reporting ProgramAct as primary contact for regulatory reporting submissionsDistribute requests to staff as neededReview reports to ensure accuracyDevelop and maintain training and requirements documentation and instructions and provide training as requiredSupport business units in interpretation of regulations related to their applicable areas as well as aid in developing appropriate tools to ensure complianceManage staff who will:Submit reports to regulatorsSubmit materials to regulatorsCoordinate attestations from Senior Leadership for submissionCompliance Regulatory Guidance DistributionMonitor and distribute regulatory memos such as State memos, HPMS memos, Final Rules and other regulatory guidance released from governing bodies to the businessTrack action items resulting from regulatory memos to ensure timely completionProvide guidance to the organization on interpretation of regulatory guidanceCreate trainings as needed to implement new requirementsWorking 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 and communication 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 ability to identify an issue, conduct an analysis to determine business impact (including gap analyses), troubleshoot.Strong project management skills - having the 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 to continue 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 and owners to resolve issues in a timely manner.Requires diplomatic and negotiation skills and understanding of needs of internal and external partners.Ability to work independently.Ability to present information clearly in meetings and to communicate with team members and senior leadership.Requires excellent interpersonal skills in order to communicate and work with staff of all skill and experience levels.Self-directed with proven initiation skills.Must be able to effectively communicate with colleagues, internal customers, and vendors.Required Language (must have):English
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