Compliance Manager

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Job Description

A bit about this role: 

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  We are seeking an experienced Compliance Manager to lead and oversee a team of analysts in efforts to identify, prevent and mitigate Medicare beneficiary complaints and healthcare fraud, waste and abuse
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  As the Compliance Manager for Devoted Health, you will be supporting the Director of Sales Compliance in the oversight of internal sales agents, external brokers and TPMO’s in accordance with regulatory requirements.
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  You will be managing marketing complaints investigations against sales agents, tracking and trending complaints, conducting  risk assessments, assisting in audits, developing audit tools, tracking potential compliance issues, and assisting in the day to day monitoring of the Medicare business.

Your Responsibilities and Impact will include:

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  Oversee a team of Compliance Analysts responsible to conduct agent investigations, ensuring efficient case management and timely resolution to meet department and organizational goals.
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  Lead special agent and/or TPMO investigations targeting fraud, waste and abuse, utilizing analytical skills to identify potential compliance issues and recommending corrective actions. 
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  Collect, analyze, and track complaint data to identify trends, patterns, and potential compliance issues; prepare reports and recommendations for management and key stakeholders.
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  Identify and timely report compliance issues discovered during investigations to senior management, Third Party Marketing Organization (TPMO) leadership and relevant stakeholders, ensuring transparency, accountability and timely action.
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  Serve as the key liaison between Compliance, sales leaders, and TPMO’s regarding complaint investigations and compliance matters. 
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  Manage the corrective actions resulting from investigations, including  processing agent terminations in compliance with CMS and DOI regulations. 
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  Regularly monitor compliance dashboards to track key performance indicators and team productivity to ensure ongoing adherence to compliance standards. 
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  Prepare and present findings, insights, and trends related to complaint data to sales  leadership, TPMO’s and other internal areas to promote awareness and drive improvement. 
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  Perform and assist with internal audits, corrective actions, and root cause analysis projects.
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  Review HPMS memos and regulatory guidance for adherence to regulatory processes.
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  Analyze, research, develop, write, edit, review and distribute policy and procedure documents according to the company’s standards and CMS requirements. 
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  Identifies potential risks/deficiencies with our internal business areas and/or TPMOs to avoid possible compliance issues and improve business productivity/efficiency.
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  Lead, develop and mentor team members

Required skills and experience:

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  Bachelor’s degree in Business Administration, Healthcare Administration, Criminal Justice or related field.
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  The ideal candidate must have experience in conducting complaint investigations against sales agents, with a strong focus on special investigations involving fraud, waste and abuse. 
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  Minimum of 3-5 years experience in compliance, investigations or related field within the healthcare or Medicare Advantage industry with direct knowledge of CMS Medicare regulations and compliance programs for Medicare Advantage (MA), Medicare Advantage Prescription Drug (MAPD), and/or Prescription Drug Plans (PDP) is required.
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  Strong understanding of CMS regulations and DOI requirements  related to agent conduct and compliance. 
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  Excellent analytical skills, with the ability to interpret complex data,  identify trends, report results and produce actionable insights. 
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  Experience in conducting audits, and developing audit tools.
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  Strong verbal and written communication skills, comfortable  with public speaking,  with the ability to communicate effectively with internal and external stakeholders. 
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  Effective organizational and time management skills with the ability to handle multiple tasks and/or projects and meet deadlines. 
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  Reporting, use of excel, google spreadsheets and other data collection and reporting software.
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  Ability to develop, implement, track progress, and report on objectives, projects, timelines, and deliverables for the compliance program.
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  Strong leadership and interpersonal skills with ability to collaborate with a diverse group of people internally across the organization and externally, as well as working independently to get the job done.
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  Detail oriented, curious and inquisitive- eager to learn
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  Ability to Travel 10% (onsite meetings, audits, and conferences)

Desired skills and experience:

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  Certified Fraud Examiner

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  Employer sponsored health, dental and vision plan with low or no premium
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  Generous paid time off
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  $100 monthly mobile or internet stipend
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  Stock options for all employees
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  Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
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  Parental leave program
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  401K program
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  And more....