Senior Compliance Administrator – Network, Provider, Product

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 guidelines and relevant federal and state laws.

• Offer regulatory insights, perform research and analysis, monitor issues, aid in audit preparedness, and support compliance workplan initiatives.

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

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

• Develop and manage regulatory communications, such as responses to inquiries, issue summaries, and disclosures.

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

• Recognize compliance risks, evaluate business-process exposure, perform risk stratification, and propose mitigation strategies.

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

• Aid in audit and monitoring efforts, including audit scope development, testing methods, and continuous compliance oversight.

• Collaborate with stakeholders on audit execution, regulatory assessments, and audit readiness.

• Assess remediation plans and verify the effectiveness of corrective actions.

• Participate in compliance training and provide mentorship to stakeholders on regulatory requirements, policies, and best practices.

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

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

• Keep abreast of regulatory changes and industry trends.

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

• Undertake additional responsibilities as assigned.

• Adhere to all organizational policies and standards.

⛳️ Requirements

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

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

• At least 4 years of advisory experience in compliance, including regulatory research, drafting compliance guidance, assessing risks, tracking issues, auditing/monitoring, and managing corrective action plans.

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

• Fundamental understanding of Medicare regulations, including CMS guidance and compliance requirements (e.g., Parts C & D).

• Excellent written and verbal communication skills.

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

• Ability to juggle 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 in a matrixed or cross-functional environment 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.