Government Programs Compliance Lead
Core
Senior subject matter expert supporting the Medicare Compliance Officer to operationalize and enhance the compliance program for Medicare Advantage (Part C) and Part D operations, ensuring alignment with CMS requirements.
Role type
Senior IC compliance lead (healthcare/government programs)
Builds
Embedded business processes and compliance controls for claims, pharmacy, utilization management, and appeals
Domain
Healthcare (Medicare) + Regulatory Compliance
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
CMS Medicare regulations expertise, 7 Elements of Effective Compliance Program, Fraud Waste and Abuse detection, regulatory gap analysis, auditing and monitoring, corrective action planning, governance and reporting
Preferred skills
Experience with EGWP plans, deep knowledge of Part D/MA-PD program requirements
Technologies
HPMS, CMS manuals, 42 CFR Parts 422/423
Responsibilities
Develop and implement policies and procedures, conduct training and awareness initiatives, perform monitoring and auditing, investigate issues and plan corrective actions, translate regulatory requirements into operational workflows, support risk assessment activities
Seniority
Senior, hands-on IC
