Harris Health System, Inc.
Medicare Compliance Program Manager
Harris Health System, Inc., Houston, Texas, United States, 77246
JOB SUMMARY
The Medicare Compliance Program Manager leads and maintains CHC compliance program for Dual-Eligible Special Needs Plans (D-SNP). This position ensures adherence to Medicare Advantage Part C & D, D-SNP, and State Medicaid Agency Contract (SMAC) requirements through proactive monitoring, regulatory interpretation, and collaboration across functional areas. The Program Manager manages HPMS notices and Medicare Final Rules, validates implementation of regulatory changes, oversees required reporting and attestations, and serves as the compliance subject matter expert for D-SNP operations. The role partners closely with legal, operations, and regulatory stakeholders to maintain alignment with CMS and state requirements. JOB SPECIFICATIONS AND CORE COMPETENCIES
D-SNP Compliance Monitoring & Oversight
The Program Manager monitors all operational activities related to Medicare Advantage, Part D, D-SNP, and TX HHSC SMAC requirements. The role evaluates performance against regulatory benchmarks, identifies risks and trends, and collaborates with operational teams to implement corrective action plans. The role maintains compliance dashboards and metrics, escalates issues as appropriate, and reviews member-facing materials and communications to ensure consistency with CMS and SMAC requirements. HPMS Notices & Regulatory Guidance Management
This role monitors, reviews, and distributes HPMS memos, Final Rules, and other regulatory guidance impacting D-SNP operations. The Program Manager develops and shares internal guidance to ensure stakeholders understand changes and validates that all mandated updates are incorporated into policies, procedures, systems, and training programs. Attestation, Reporting, and State/SMAC Contract Oversight
The Program Manager oversees the preparation, coordination, and submission of all required attestations to CMS and Texas HHSC for D-SNP plans. The role ensures compliance with state-level regulatory requirements and coordinates updates related to the State Medicaid Agency Contract. The Program Manager manages timely and accurate reporting such as Part C & D reporting, PDE submissions, and other SMAC deliverables. Organizational Compliance Strategy & Stakeholder Collaboration
The Program Manager contributes to the annual Medicare/D-SNP compliance work plan by tracking progress and reporting outcomes. The role serves as a compliance subject matter expert across CHC, providing guidance to operations, product development, and marketing on D-SNP requirements. Additionally, the Program Manager supports new business and contract implementations, including review of SMAC obligations and unique state-level rules. Actively contributes to the achievement of departmental goals, as identified in the Departments annual business plan, including specific departmental process improvement plans, and other duties as assigned.
QUALIFICATIONS
Education/Specialized Training/Licensure: Bachelor's degree in healthcare administration, Compliance, Business, or related field, or equivalent combination of education and relevant experience required. Masters in healthcare administration, Public Health, Business, or related field preferred. Certification in Healthcare Compliance (CHC) or equivalent compliance credential. Work Experience (Years and Area): 6 years of experience in healthcare compliance, including Medicare Advantage / Part D; at least 1-2 years directly involved with D-SNP or duals programs required. Strong knowledge of CMS Medicare regulations, HPMS, State Medicaid/SMAC management required. Demonstrated experience with compliance monitoring, regulatory implementation, attestation/reporting oversight required. 5-7 years of progressive compliance experience with a Medicare health plan, with at least 2 years of experience with D-SNPs preferred. Direct experience with D-SNP model of care, HIDE plans and Medicare Program audits preferred. Prior responsibility with leading Medicare compliance program oversight preferred. Management Experience (Years and Area): 0-2 years of compliance management required; 2 or more years of compliance management preferred. Software Proficiencies: Microsoft Office Suite (Word, Excel, PowerPoint, Teams) and regulatory/compliance tracking systems. Data reporting and dashboard tools required. Experience implementing a regulatory compliance tracking system (GRC tool) preferred. JOB FAMILY/ JOB TITLE COMPETENCIES
Analytical Thinking Attention to Detail Planning and Organizing Critical Thinking
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The Medicare Compliance Program Manager leads and maintains CHC compliance program for Dual-Eligible Special Needs Plans (D-SNP). This position ensures adherence to Medicare Advantage Part C & D, D-SNP, and State Medicaid Agency Contract (SMAC) requirements through proactive monitoring, regulatory interpretation, and collaboration across functional areas. The Program Manager manages HPMS notices and Medicare Final Rules, validates implementation of regulatory changes, oversees required reporting and attestations, and serves as the compliance subject matter expert for D-SNP operations. The role partners closely with legal, operations, and regulatory stakeholders to maintain alignment with CMS and state requirements. JOB SPECIFICATIONS AND CORE COMPETENCIES
D-SNP Compliance Monitoring & Oversight
The Program Manager monitors all operational activities related to Medicare Advantage, Part D, D-SNP, and TX HHSC SMAC requirements. The role evaluates performance against regulatory benchmarks, identifies risks and trends, and collaborates with operational teams to implement corrective action plans. The role maintains compliance dashboards and metrics, escalates issues as appropriate, and reviews member-facing materials and communications to ensure consistency with CMS and SMAC requirements. HPMS Notices & Regulatory Guidance Management
This role monitors, reviews, and distributes HPMS memos, Final Rules, and other regulatory guidance impacting D-SNP operations. The Program Manager develops and shares internal guidance to ensure stakeholders understand changes and validates that all mandated updates are incorporated into policies, procedures, systems, and training programs. Attestation, Reporting, and State/SMAC Contract Oversight
The Program Manager oversees the preparation, coordination, and submission of all required attestations to CMS and Texas HHSC for D-SNP plans. The role ensures compliance with state-level regulatory requirements and coordinates updates related to the State Medicaid Agency Contract. The Program Manager manages timely and accurate reporting such as Part C & D reporting, PDE submissions, and other SMAC deliverables. Organizational Compliance Strategy & Stakeholder Collaboration
The Program Manager contributes to the annual Medicare/D-SNP compliance work plan by tracking progress and reporting outcomes. The role serves as a compliance subject matter expert across CHC, providing guidance to operations, product development, and marketing on D-SNP requirements. Additionally, the Program Manager supports new business and contract implementations, including review of SMAC obligations and unique state-level rules. Actively contributes to the achievement of departmental goals, as identified in the Departments annual business plan, including specific departmental process improvement plans, and other duties as assigned.
QUALIFICATIONS
Education/Specialized Training/Licensure: Bachelor's degree in healthcare administration, Compliance, Business, or related field, or equivalent combination of education and relevant experience required. Masters in healthcare administration, Public Health, Business, or related field preferred. Certification in Healthcare Compliance (CHC) or equivalent compliance credential. Work Experience (Years and Area): 6 years of experience in healthcare compliance, including Medicare Advantage / Part D; at least 1-2 years directly involved with D-SNP or duals programs required. Strong knowledge of CMS Medicare regulations, HPMS, State Medicaid/SMAC management required. Demonstrated experience with compliance monitoring, regulatory implementation, attestation/reporting oversight required. 5-7 years of progressive compliance experience with a Medicare health plan, with at least 2 years of experience with D-SNPs preferred. Direct experience with D-SNP model of care, HIDE plans and Medicare Program audits preferred. Prior responsibility with leading Medicare compliance program oversight preferred. Management Experience (Years and Area): 0-2 years of compliance management required; 2 or more years of compliance management preferred. Software Proficiencies: Microsoft Office Suite (Word, Excel, PowerPoint, Teams) and regulatory/compliance tracking systems. Data reporting and dashboard tools required. Experience implementing a regulatory compliance tracking system (GRC tool) preferred. JOB FAMILY/ JOB TITLE COMPETENCIES
Analytical Thinking Attention to Detail Planning and Organizing Critical Thinking
#J-18808-Ljbffr