Position Purpose: Serves as an individual contributor and subject matter expert responsible for supporting the day-to-day execution of the Medicare Compliance Advisory program in alignment with CMS requirements and applicable federal and state regulations. Provides trusted advisory support to business and compliance leadership by providing regulatory guidance, conducting research and analysis, tracking issues, contributing to audit readiness and supporting compliance workplan activities. This role partners closely with the Sr. Manager, Medicare Compliance Advisory, to ensure accurate interpretation of CMS requirements, timely completion of assignments, and consistent documentation of compliance risks, trends, and corrective actions.
- Execute the Medicare Compliance Program in alignment with CMS and applicable federal and state regulations, ensuring prevention, detection, and correction of noncompliance and FWA.
- Interprets and translates federal, state, and contractual requirements into clear, actionable compliance guidance for business stakeholders, ensuring consistent understanding and application across operations.
- Develops and coordinates regulatory communications, including responses to inquiries, issue summaries, and disclosures, while serving as a liaison with internal stakeholders and external regulators as appropriate.
- Supports the preparation, validation, and submission of regulatory reports, attestations, and filings, ensuring accuracy, completeness, and timeliness of all deliverables.
- Proactively identifies compliance risks and evaluates business processes to assess exposure, provide risk stratification, and recommend mitigation strategies.
- Leads or supports issue identification, root cause analysis, and development of corrective action plans to ensure effective and compliant resolution of identified gaps.
- Provides subject matter expertise to audit and monitoring activities, including supporting audit scope development, testing strategies, and ongoing compliance oversight.
- Partners with internal and external stakeholders to support audit execution, regulatory reviews, and ongoing audit readiness activities.
- Evaluates remediation plans and validates corrective actions to ensure sustainable and compliant resolution of issues, including assessment of regulatory reporting or disclosure requirements.
- Contributes to the development and delivery of compliance training, while mentoring stakeholders on regulatory requirements, policies, and best practices.
- Reviews and assesses policies, procedures, and business processes to ensure alignment with regulatory and contractual requirements and organizational standards.
- Leads or contributes to cross-functional initiatives to enhance compliance processes, drive operational efficiency, and align compliance activities with organizational objectives.
- Monitors regulatory developments and industry trends to identify emerging risks and support continuous improvement of compliance programs.
- Collaborates with compliance, legal, audit, and operational partners to ensure coordinated execution of compliance activities across business areas.
- Performs other duties as assigned.
- Complies with all policies and standards.
Education/Experience:
- Bachelor’s degree in a related field (e.g., healthcare administration, public health, policy) or equivalent experience required. Master's Degree or Juris Doctor preferred.
- 5+ years Compliance, regulatory, operations, or risk management within a regulated industry (e.g., healthcare, managed care, insurance, or public sector).
- 4+ years Compliance advisory experience to include regulatory research and drafting compliance guidance, assessing risk, issue tracking, auditing / monitoring, and overseeing the development and implementation of correction action plans