Senior Compliance Administrator – Enrollment, Billing, Finance, DIR

This is a fully remote position, open to applicants in Connecticut, +8 more states.

📋 Description

• Assist with the daily implementation of the Medicare Compliance Advisory program in accordance with CMS standards and relevant federal and state regulations.

• Implement the Medicare Compliance Program to prevent, identify, and rectify noncompliance and fraud, waste, and abuse (FWA).

• Analyze and convert federal, state, and contractual requirements into practical compliance directives.

• Create and manage regulatory communications, including responses to inquiries, summaries of issues, and disclosures.

• Aid in the preparation, validation, and submission of regulatory reports, attestations, and filings.

• Recognize compliance risks, evaluate business processes, assess vulnerabilities, and propose mitigation strategies.

• Lead or assist in identifying issues, conducting root cause analyses, and formulating corrective action plans.

• Provide expertise in support of audit and monitoring activities.

• Assist in the execution of audits, regulatory reviews, and maintain ongoing audit preparedness.

• Assess remediation plans and confirm corrective actions.

• Contribute to compliance training and guide stakeholders on regulatory requirements and best practices.

• Examine policies, procedures, and business processes to ensure regulatory and contractual compliance.

• Lead or participate in cross-functional compliance initiatives and process enhancements.

• Stay informed on regulatory changes and industry trends.

• Work collaboratively with compliance, legal, audit, and operational partners.

• Perform additional duties as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• Bachelor’s degree in a relevant field (such as healthcare administration, public health, or policy) or equivalent experience is required.

• Over 5 years of experience in Compliance, regulatory, operations, or risk management within a regulated sector.

• More than 4 years of Compliance advisory experience, including regulatory research, drafting compliance guidance, risk assessment, issue tracking, auditing/monitoring, and managing corrective action plans.

• At least 2 years of experience supporting managed care, Medicare Advantage/Part D, or Dual Eligible (DSNP) programs.

• Foundational knowledge of Medicare regulations, including CMS guidance and compliance expectations (e.g., Parts C & D).

• Excellent written and verbal communication skills.

• Strong analytical, organizational, and documentation skills with a keen attention to detail.

• Capability to handle multiple assignments and meet deadlines in a dynamic environment.

• Certification in Healthcare Compliance (CHC) is preferred.

• Familiarity with CMS audit protocols, program audits, or monitoring activities is preferred.

• Experience working in a matrixed or cross-functional setting is preferred.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K and stock purchase options.

• Tuition reimbursement opportunities.

• Paid time off in addition to holidays.

• Flexible work arrangements, including remote, hybrid, field, or office schedules.

• Additional incentive options may be included in the overall compensation package.