Compliance Lead
Core
Ensures compliance with governmental requirements, specifically overseeing Medicare Part C claims and developing/implementing compliance policies.
Role type
Senior individual contributor compliance lead
Builds
Compliance policies, audit methodologies, and regulatory guidance for Medicare Part C claims
Domain
Healthcare insurance / Medicare regulatory compliance
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Medicare Part C claims expertise, regulatory research and application, audit methodology development, data analysis and validation, executive advisory, independent judgment on complex compliance issues
Preferred skills
Project management, Six Sigma methodology, advanced graduate degree, leadership experience
Technologies
None explicitly stated
Responsibilities
Research and apply laws/regulations for Medicare Part C claims, develop audit methodology to detect noncompliance, analyze business requirements and provide regulatory guidance, track compliance metrics, lead onsite program audit preparation, present monitoring findings to leadership, participate in compliance committees
Seniority
Senior, individual contributor