Lead Compliance Program Manager
Point32Health, Canton, MA, United States
Point32Health is a leading not-for-profit health and well‑being organization dedicated to delivering high‑quality, affordable healthcare. Serving nearly 2 million members, we build on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We have a long‑standing commitment to inclusion and equal healthcare access and outcomes, regardless of background. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.
Job Summary
The Lead Compliance Program Manager will develop, implement, and manage significant and complex compliance programs, initiatives, and projects associated with federal and state regulations for applicable lines of business (Corporate, Commercial, Medicare, Duals, and/or Medicaid). The role partners with internal departments as well as external stakeholders, including government regulators and auditors. Responsibilities include collaborating with leadership to define and execute strategic compliance initiatives, performing risk analysis, facilitating cross‑departmental meetings, and maintaining an effective compliance program.
Key Responsibilities
Provide support in overall management of the compliance program key functions, including developing compliance workplans across all elements of an effective compliance program (Risk Assessment; Monitoring and Auditing; Effective Communication; Training and Education; Policies and Procedures; Vendor Oversight; Issue correction and remediation).
Ensure ongoing compliance with established, revised, or new regulatory requirements that impact the organization, including delivery of benefits for members.
Oversee the compliance program through employee and leadership communications, coordination of policy development, and accurate, timely communication to all departments.
Conduct risk assessments, focused reviews, and/or audits to identify potential compliance issues and vulnerabilities; develop remediation plans.
Manage significant or complex regulatory audits to ensure timely completion of data and documentation collection, review, and submission; support development of responses and track monitoring of remediation actions.
Lead and/or manage projects and initiatives, representing regulatory and compliance expectations during planning and implementation phases; coordinate issue resolution with relevant functional business areas; lead planning and review sessions.
Evaluate and analyze regulations and sub‑regulatory guidance, interpret their significance, and recommend and review policies to ensure compliance.
Manage tracking, investigation, and resolution of compliance oversight activities such as issue management, monitoring and auditing; lead and coordinate responses to compliance violations and incidents.
Investigate instances of suspected noncompliance within the health plan and report to appropriate management and regulators, if required.
Prepare monthly and/or quarterly compliance reporting for the organization’s leadership and committees.
Understand regulatory requirements and industry to drive a successful compliance program through prevention, detection, and correction of potential issues of noncompliance and/or fraud.
Qualifications – What You Need To Perform The Job
Education, Certification and Licensure
Bachelor’s degree in business, law, compliance, or a related field preferred.
Advanced degrees and relevant certifications are a plus.
Experience (minimum Years Required)
8 or more years of regulatory, compliance, and legislative activities, health insurance operations, or legal research, or equivalent combination of education and experience.
3–5 years of Medicare, Medicaid and/or Commercial compliance experience.
Demonstrated knowledge of government regulations as they relate to the administration of Medicare and/or Medicaid healthcare programs, principles, and practices of managed care.
Skill Requirements
Excellent verbal and written communication skills; ability to facilitate planning and review sessions.
High‑level presentation skills; ability to interface effectively with internal and external contacts and present technical information in a way that establishes rapport and gains understanding.
Ability to exercise sound judgment and raise issues and potential solutions to appropriate team members or management for resolution.
Ability to conceptualize the impact of change and propose new methods of conducting business.
Strong analytical skills to develop and implement change to existing program functions.
Ability to interpret and explain the implications of planned changes to current state business units.
Ability to problem‑solve and overcome obstacles to ensure successful program operations.
Technical Skills
Proficiency with Microsoft Office applications (Word, Excel, PowerPoint).
Ability to utilize multiple applications simultaneously.
Interpersonal Skills
Ability to work cooperatively as part of a team.
Effective communication with all internal departments in verbal and written formats.
Ability to work in a matrix environment with minimal supervision.
Knowledge of the company to resolve most roadblocks to program progress; ability to operate in a matrixed‑management, consultative environment.
Ability to coach or mentor less experienced staff and lead in a matrixed environment.
Proactive identification of conflict/integration issues and leadership of team members to synthesize complex issues; ability to develop risk analysis for consideration.
Detailed content knowledge of the specific program; ability to converse and lead dialogue on the subject with minimal direction.
Flexibility and advocacy for change; ability to envision impact of change and propose new ways to do business.
Working Conditions and Additional Requirements
Fast‑paced office environment handling multiple demands.
Ability to work under normal office conditions and work from home as required.
Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
May require additional hours beyond the standard work schedule.
Disclaimer
The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.
Salary Range
$108,842.63 – $163,263.95
Compensation & Total Rewards Overview
The annual base salary range for this position represents a range of salaries for this role and similar roles across the organization. The actual salary will be determined by factors including the scope and complexity of the role, the skills, education, training, credentials, and experience of the candidate, and internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or other compensation and benefits remains at the Company’s sole discretion and may be modified in accordance with the law.
Benefits
Medical, dental and vision coverage
Retirement plans
Paid time off
Employer‑paid life and disability insurance with additional buy‑up coverage options
Tuition program
Well‑being benefits
Full suite of benefits to support career development, individual & family health, and financial health
We welcome all
All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Scam Alert
Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org
#J-18808-Ljbffr
Job Summary
The Lead Compliance Program Manager will develop, implement, and manage significant and complex compliance programs, initiatives, and projects associated with federal and state regulations for applicable lines of business (Corporate, Commercial, Medicare, Duals, and/or Medicaid). The role partners with internal departments as well as external stakeholders, including government regulators and auditors. Responsibilities include collaborating with leadership to define and execute strategic compliance initiatives, performing risk analysis, facilitating cross‑departmental meetings, and maintaining an effective compliance program.
Key Responsibilities
Provide support in overall management of the compliance program key functions, including developing compliance workplans across all elements of an effective compliance program (Risk Assessment; Monitoring and Auditing; Effective Communication; Training and Education; Policies and Procedures; Vendor Oversight; Issue correction and remediation).
Ensure ongoing compliance with established, revised, or new regulatory requirements that impact the organization, including delivery of benefits for members.
Oversee the compliance program through employee and leadership communications, coordination of policy development, and accurate, timely communication to all departments.
Conduct risk assessments, focused reviews, and/or audits to identify potential compliance issues and vulnerabilities; develop remediation plans.
Manage significant or complex regulatory audits to ensure timely completion of data and documentation collection, review, and submission; support development of responses and track monitoring of remediation actions.
Lead and/or manage projects and initiatives, representing regulatory and compliance expectations during planning and implementation phases; coordinate issue resolution with relevant functional business areas; lead planning and review sessions.
Evaluate and analyze regulations and sub‑regulatory guidance, interpret their significance, and recommend and review policies to ensure compliance.
Manage tracking, investigation, and resolution of compliance oversight activities such as issue management, monitoring and auditing; lead and coordinate responses to compliance violations and incidents.
Investigate instances of suspected noncompliance within the health plan and report to appropriate management and regulators, if required.
Prepare monthly and/or quarterly compliance reporting for the organization’s leadership and committees.
Understand regulatory requirements and industry to drive a successful compliance program through prevention, detection, and correction of potential issues of noncompliance and/or fraud.
Qualifications – What You Need To Perform The Job
Education, Certification and Licensure
Bachelor’s degree in business, law, compliance, or a related field preferred.
Advanced degrees and relevant certifications are a plus.
Experience (minimum Years Required)
8 or more years of regulatory, compliance, and legislative activities, health insurance operations, or legal research, or equivalent combination of education and experience.
3–5 years of Medicare, Medicaid and/or Commercial compliance experience.
Demonstrated knowledge of government regulations as they relate to the administration of Medicare and/or Medicaid healthcare programs, principles, and practices of managed care.
Skill Requirements
Excellent verbal and written communication skills; ability to facilitate planning and review sessions.
High‑level presentation skills; ability to interface effectively with internal and external contacts and present technical information in a way that establishes rapport and gains understanding.
Ability to exercise sound judgment and raise issues and potential solutions to appropriate team members or management for resolution.
Ability to conceptualize the impact of change and propose new methods of conducting business.
Strong analytical skills to develop and implement change to existing program functions.
Ability to interpret and explain the implications of planned changes to current state business units.
Ability to problem‑solve and overcome obstacles to ensure successful program operations.
Technical Skills
Proficiency with Microsoft Office applications (Word, Excel, PowerPoint).
Ability to utilize multiple applications simultaneously.
Interpersonal Skills
Ability to work cooperatively as part of a team.
Effective communication with all internal departments in verbal and written formats.
Ability to work in a matrix environment with minimal supervision.
Knowledge of the company to resolve most roadblocks to program progress; ability to operate in a matrixed‑management, consultative environment.
Ability to coach or mentor less experienced staff and lead in a matrixed environment.
Proactive identification of conflict/integration issues and leadership of team members to synthesize complex issues; ability to develop risk analysis for consideration.
Detailed content knowledge of the specific program; ability to converse and lead dialogue on the subject with minimal direction.
Flexibility and advocacy for change; ability to envision impact of change and propose new ways to do business.
Working Conditions and Additional Requirements
Fast‑paced office environment handling multiple demands.
Ability to work under normal office conditions and work from home as required.
Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
May require additional hours beyond the standard work schedule.
Disclaimer
The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.
Salary Range
$108,842.63 – $163,263.95
Compensation & Total Rewards Overview
The annual base salary range for this position represents a range of salaries for this role and similar roles across the organization. The actual salary will be determined by factors including the scope and complexity of the role, the skills, education, training, credentials, and experience of the candidate, and internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or other compensation and benefits remains at the Company’s sole discretion and may be modified in accordance with the law.
Benefits
Medical, dental and vision coverage
Retirement plans
Paid time off
Employer‑paid life and disability insurance with additional buy‑up coverage options
Tuition program
Well‑being benefits
Full suite of benefits to support career development, individual & family health, and financial health
We welcome all
All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Scam Alert
Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org
#J-18808-Ljbffr