Compliance Director of Medicare-Medicaid
Neighborhood Health Plan (NHP) - Boston, MA

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Neighborhood Health Plan (NHP), located in Boston, is currently seeking an experienced, highly skilled Compliance Director of Medicare-Medicaid . NHP is one of six Integrated Care Organizations in Massachusetts moving forward to participate in a new federal-state demonstration project designed to improve care for dually eligible beneficiaries ages 21-64. The Director is charged with developing and implementing business plans to ensure compliance with this new program, the NHP Complete Care Plan, and to ensure high-quality written policies, procedures, and standards of conduct related to all applicable state and federal standards.

Primary Responsibilities:
  • Oversee and monitor the implementation of the NHP Complete Care Plan compliance program
  • Develop and implement appropriate compliance tracking and reporting systems for the NHP Complete Care Plan
  • Serve as the principal contact with government agencies on Medicare-Medicaid compliance matters
  • Develop, coordinate, and participate in a multifaceted educational and training program that focuses on the elements of the compliance program and seeks to ensure that all appropriate employees and management are knowledgeable of, and comply with, pertinent federal and state standards
  • Ensure that all business units receive timely and accurate regulatory guidance
  • Provide interpretive and technical support for business units on regulatory matters
  • Periodically revise the program in light of changes in the needs of the organization, and in the law, policies and procedures of government payers
  • Ensure that FDRs who furnish services to NHP Complete Care Program are aware of the requirements of the compliance program with respect to coding, coverage, billing, and marketing, among other things
  • Monitor FDRs to ensure their participation in Medicare Compliance and FWA training and their development and implementation of a compliance program that meets the requirements of CMS and EOHHS

Preferred Qualifications:
  • Graduate degree or equivalent experience in health law, health plan management, public policy or public administration, business administration, public health, or a related field is required
  • 7 years of work experience in compliance related activities, legislative and regulatory activities, health plan operations or legal research or equivalent combination of education and job-related work experience
  • Knowledge and experience in Medicare Compliance activities - working effectively with CMS and key internal stakeholders in identifying, addressing, ameliorating and preventing compliance concerns and problems
  • Work experience at CMS, MassHealth, or Medicare Advantage plans a plus

Strong understanding of the following:
  • Health policy issues related to medical and other health care activities including, but not limited to, health care finance and a broad range of health care public policy issues
  • Health insurance, including state, federal and managed care program requirements, with an emphasis on Medicare health care laws and regulations
  • Government regulations as they relate to the administration of Medicare health care programs, particularly compliance, and principles and practices of managed care
  • Health plan and Medicare legislation and regulations, including government contract benefits policies and practices, rules and regulations for Medicare products along with knowledge of leadership techniques and approaches to ensure effectiveness in leading a multi-layer organization

Must have:
  • Inquisitive analytical and research skills. Big picture planning and organizational communication and strong interpersonal skills are a must
  • Ability to work effectively among a wide range of constituents and meet aggressive time schedules
  • Ability to effectively organize and manage meetings and develop and maintain and execute work plans
  • Excellent oral, including presentations, and written communication skills
  • Proficient computer skills, including MS Word, Excel, and Internet web research skills
NHP offers competitive salaries and an excellent flexible benefits package that includes medical, dental and vision insurance, generous earned time, commuter benefit, and a 401(k) employer contributed retirement program.

NHP’s mission targets a diverse population and our employees are just as diverse. As an equal opportunity employer, NHP recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives, and backgrounds.


Neighborhood Health Plan (NHP) - 13 months ago - save job - block
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