Mass General Brigham Health Plan
Senior Vendor Compliance Program Manager
Mass General Brigham Health Plan, Somerville, Massachusetts, us, 02145
Overview
In collaboration with the Senior Director, Government programs, manage the vendor oversight programs for government payer programs (Medicare Advantage, Part D, Dual Special Needs Programs) and state insurance programs. Set up the vendor oversight models, intake monitoring performance reports and evaluate compliance and initiate corrective action and/or process improvement activities. Collaborate with the business to set up oversight model that ensures all services delegates are managed in a compliant and timely way. Responsibilities
Managed vendor corrective action plan processes Conduct annual compliance risk assessment of vendors and use results to help craft annual monitoring and auditing program Perform annual outreach to vendors to validate its adherence to several federal vendor requirements Perform monthly checks of vendor information against government exclusion lists to ensure vendors are eligible for government program participation and payment Ensure vendors are prepared to participate in external audits with regulatory agencies Education
Bachelor's Degree Related Field of Study required and Master\'s Degree Related Field of Study preferred. Experience can be substituted in lieu of a degree Licenses and Credentials
Any certification in health care compliance preferred. Experience
At least 8-10 years of program management experience required At least 1-2 years of team leadership experience required Knowledge, Skills, and Abilities
Strong oral and written communication skills. Ability to deliver presentations to a wide variety of audiences. Ability to effectively plan and facilitate meetings and workgroups. Excellent organizational skills and attention to detail, ability to work independently, manage multiple tasks and projects, meet deadlines, and manage a schedule. Working Conditions
This is a hybrid role that requires an on-site presence at the office in Assembly Row, Somerville, 2-3x/month Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
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In collaboration with the Senior Director, Government programs, manage the vendor oversight programs for government payer programs (Medicare Advantage, Part D, Dual Special Needs Programs) and state insurance programs. Set up the vendor oversight models, intake monitoring performance reports and evaluate compliance and initiate corrective action and/or process improvement activities. Collaborate with the business to set up oversight model that ensures all services delegates are managed in a compliant and timely way. Responsibilities
Managed vendor corrective action plan processes Conduct annual compliance risk assessment of vendors and use results to help craft annual monitoring and auditing program Perform annual outreach to vendors to validate its adherence to several federal vendor requirements Perform monthly checks of vendor information against government exclusion lists to ensure vendors are eligible for government program participation and payment Ensure vendors are prepared to participate in external audits with regulatory agencies Education
Bachelor's Degree Related Field of Study required and Master\'s Degree Related Field of Study preferred. Experience can be substituted in lieu of a degree Licenses and Credentials
Any certification in health care compliance preferred. Experience
At least 8-10 years of program management experience required At least 1-2 years of team leadership experience required Knowledge, Skills, and Abilities
Strong oral and written communication skills. Ability to deliver presentations to a wide variety of audiences. Ability to effectively plan and facilitate meetings and workgroups. Excellent organizational skills and attention to detail, ability to work independently, manage multiple tasks and projects, meet deadlines, and manage a schedule. Working Conditions
This is a hybrid role that requires an on-site presence at the office in Assembly Row, Somerville, 2-3x/month Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
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