Compliance Manager, Healthcare

The Compliance Manager will play a critical role in ensuring the health plan adheres to all regulatory requirements, with a primary focus on Centers for Medicare & Medicaid Services (CMS) audits and compliance activities. This position involves monitoring, auditing, and implementing compliance programs to maintain regulatory integrity and minimize risk.

• CMS Audit Management
• Coordinate and support CMS program audits, including preparation, submission of documentation, and response to audit inquiries.
• Maintain audit readiness by ensuring compliance with CMS guidelines and internal policies.
• Track and manage corrective action plans resulting from audits.
• Regulatory Compliance
• Monitor and interpret CMS regulations, guidance, and updates to ensure timely implementation within the health plan.
• Develop and maintain compliance policies and procedures aligned with federal and state requirements.
• Conduct internal compliance reviews and risk assessments to identify gaps and recommend improvements.
• Reporting & Documentation
• Prepare compliance reports for leadership and regulatory bodies.
• Maintain accurate records of compliance activities, audit findings, and remediation efforts.
• Training & Education
• Provide compliance training to internal teams on CMS requirements and best practices.
• Serve as a subject matter expert for CMS compliance-related inquiries.

• Education:
  
  Bachelor’s degree in Healthcare Administration, Business, or related field (Master’s preferred).
• Experience:
• Minimum 5-6 years of experience in health plan compliance, with direct involvement in CMS audits.
• Strong understanding of Medicare Advantage, Part D, and CMS regulatory requirements.
• Skills:
• Excellent organizational and project management skills.
• Strong analytical and problem-solving abilities.
• Effective communication and interpersonal skills.
• Proficiency in compliance tools and Microsoft Office Suite.