Business Compliance Lead

Employment Type

: Full-Time


: Miscellaneous

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Are you interested in becoming part of a dynamic team that is looking to innovate and improve?Would you like to work for a company that has been rated by the BBJ (15 yrs) as one of the best places to work? Do you want to be part of a company that is committed to giving back to the community?Harvard Pilgrim Health Care is currently seeking a highly motivated individual to join our organization as a Business Compliance Lead for our growing Medicare Advantage program. The Business Compliance Lead will be expected to proactively identify program or process conflicts and integration issues and recommends prioritized strategies for resolution. This individual will provide support for the pharmacy team and serve as back-up for regulatory related functions.
Design, deliver and drive internal compliance measures through the implementation of operational policies and procedures which ensure adherence to all new and changing state, federal and CMS regulations. Identify appropriate risks for any new or existing regulatory change. Understand at a high level the implications of changes and is able to synthesize information that serves the best interest of the business unit and Company.
Ensure readiness with CMS' Audit Protocols for the business unit. Conduct operational and compliance audits for Medicare Advantage within the department, recommending and implementing process improvements; assist in tracking appropriate Compliance metrics. Identify trends and knowledge gaps through audit reviews and provide feedback/recommendations. Assist in maintaining and monitoring department corrective action plans relative to audit results to ensure timely completion.
Work with numerous departments within HPHC as well as with vendors to develop inter-departmental service agreements, improve cross-functional alignment, and manage re-engineering projects to meet business goals, regulatory compliance and strategic objectives.
Develop and maintain regulatory required reporting. Participate in review of member materials to ensure that regulatory requirements are met, and information is accurate.
As subject matter expert (SME), assist the pharmacy team to ensure effective oversight and monitoring of First Tier, Related and Downstream Entities (FDRs).
Facilitate cross functional work groups as well as interdepartmental meetings as necessary.
Engage stakeholders through collaboration and openness to diverse perspectives to successfully implement change.
Facilitate planning and review sessions with HPHC senior management as it applies to the programs.
Balance directives from the centralized Compliance Function against the priorities and preferred operating model of the business unit leadership, all while serving as a centralized point of contact to streamline, manage and sustain a sound regulatory environment.
Assist with documentation and resolution of CAPs in collaboration with the pharmacy team, other HPHC business units and pharmacy vendors.
Perform out-of-the-box thinking, collaborate with others, and make a difference every day!
Other duties and projects as assigned.WHAT YOU NEED
Bachelor's degree and 8-10 years related experience in a managed health care environment
5-8 years complex project management and operational management experience.
Experience in a CMS plans (ie Medicare Advantage) required. Commercial plan experience preferred.
Understand, articulate and apply regulatory requirements
Excellent project management / program management skills
Strong ability to understand strategic objectives and develop operational processes to support these objectives; ability to connect the big picture with the operational details
Continuous improvement orientation
Ability to develop creative strategies to address problems and overcome obstacles in a rapidly changing, highly regulated environment
Ability to develop productive working relationships with colleagues in other departments
Ability to work independently and cooperatively/collaboratively as a team member
Ability to communicate effectively with internal staff at all levels
Resilient, collaborative, flexible, innovative.WHAT MAKES US STAND OUT
Paid volunteer time off (up to 3 days annually)
Open Time Off
Annual Mini-Grant of $500 donated to a non-profit organization of the employee's choice
Educational ReimbursementWorking EnvironmentOffice environment. Ability to commute to HPHC facilities.

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