Senior Compliance Administrator – Grievances, CTMs, Call Center, FDR, Off-Shore, Privacy

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

📋 Description

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

• Offer regulatory advice, perform research and analysis, monitor issues, contribute to audit preparedness, and aid in compliance workplan initiatives.

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

• Analyze and translate federal, state, and contractual requirements into practical compliance guidance.

• Create and manage regulatory communications, which include responding to inquiries, summarizing issues, and preparing disclosures.

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

• Recognize compliance risks, assess business processes, evaluate exposure, provide risk stratification, and suggest mitigation strategies.

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

• Offer subject matter expertise for audit and monitoring processes.

• Support audit execution, regulatory assessments, and maintain ongoing audit readiness.

• Review remediation plans and confirm corrective measures.

• Contribute to compliance training and mentor stakeholders on regulatory requirements, policies, and best practices.

• Evaluate policies, procedures, and business processes for regulatory and contractual consistency.

• Lead or participate in cross-functional projects aimed at improving compliance processes and operational efficiency.

• Keep abreast of regulatory changes and industry trends to identify emerging risks.

• Collaborate with compliance, legal, audit, and operational teams.

• Execute other 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 required.

• A minimum of 5 years in Compliance, regulatory affairs, operations, or risk management within a regulated sector.

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

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

• Foundational understanding 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 abilities with a keen attention to detail.

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

• A Master's Degree or Juris Doctor is preferred.

• Certification in Healthcare Compliance (CHC) is preferred.

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

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

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement programs.

• Paid time off in addition to holidays.

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

• Additional incentive options may be included in total compensation, based on eligibility.