Medicare Compliance Practices Oversight Team Lead (Full Remote)

Job Description: Compliance Practices Oversight Team Lead

Position: Compliance Practices Oversight Team Lead

Pay Rate: $55-$60 per hourPlease note this posting is listed in 3 different time zones.

Must-Have Skills:

• Knowledge of Medicare rules and regulations
• Experience with corrective action plans (CAPs)
• Audit experience

Day-to-Day Responsibilities:

• Communicate Compliance needs to the Marketing Team as new rules and regulations are established.
• Participate in audits and any corrective action plans for resolution.

Required Years of Experience:

• 5+ years of experience with managed healthcare operations or compliance, interpreting Medicare and Medicaid regulations and requirements
• 3+ years of process development/improvement experience
• 3+ years of people leadership

Required Licensure / Education:

• BA/BS or equivalent experience

Work Hours:

• 8:30 AM - 5:00 PM in their time zone (EST, CST, or PST)

Position Scope (including but not limited to):

• Legal and Compliance Support Services: Work closely with the Legal, Government Contracts, and Compliance departments to ensure proper interpretation of new rules and regulations.
• Rules and Regulations: Ensure implementation of federal and state requirements for Medicare and Medicaid for health plan content and for assigned projects and programs. Lead impact assessments and define work plans to ensure compliance when policies and regulations change. Lead the department in ongoing work related to policy and procedure documentation, revision, and maintenance.
• Internal/External Audits: Collect and validate data/sample/documentation requests; review preliminary findings with stakeholders and prepare/deliver responses.
• CAPs: Work with SMEs to document the CAP and ensure resolution; lead the team and track deliverables to ensure timely completion.
• KPIs: Report on department policy and compliance KPIs. Manage the strategic direction for the Compliance Practices Oversight team, ensuring the Marketing team is enabled to achieve and maintain consistent compliance across all requirements.
• Leadership: Lead a team of people. Establish the strategic direction, mission, and vision for the Compliance Practices Oversight team, ensuring that Marketing functions are enabled to achieve and maintain consistent compliance across all requirements.
• Other related duties may be assigned as needed.

Knowledge/Skills/Abilities:

• Organize and lead the team to meet or exceed department compliance objectives.
• Demonstrate facilitation, liaison, and negotiation skills to build consensus among diverse stakeholders.
• Strong analytical capability and comprehension of complex topics, including engaging others in understanding key concepts and their relationships.
• Support and motivate others across departments to produce required deliverables and consistently meet deadlines.
• Ability to assess deliverables produced by others and ensure those items are compliant and accurate, providing effective feedback to ensure consistent quality.
• Maintain and enhance industry and company knowledge regarding the key compliance practices outlined in the Position Scope section of this document.
• Serve as a resource and subject matter expert for compliance practices for marketing content and procedures and for health plan operational content as needed.
• Lead in the collection, consolidation, and communication of reporting data and metrics relative to each of the compliance practices.

Job Qualifications:

Re
quired Education:

• BA/BS or equivalent experience

Required Experience:

• 5+ years of experience with managed healthcare operations or compliance, interpreting Medicare and Medicaid regulations and requirements
• 3+ years of process development/improvement experience
• 3+ years of people leadership
• Strong analytical skills
• Strong problem-solving and critical thinking skills
• Highly organized and detail-oriented with proofreading and quality control skills
• Strong interpersonal, written, and verbal communication skills; ability to communicate and facilitate communication with individuals at various levels within the organization and with external vendors
• Strong technical skills using Microsoft Applications (i.e., Outlook, Word, Excel, and PowerPoint) and other databases and tools as needed
• Previous experience working with the Centers for Medicare and Medicaid Services (CMS) Health Plan Management System (HPMS)