What are the responsibilities and job description for the Director of Compliance position at Media Med?
The Director of Compliance is responsible for developing, implementing, and overseeing a comprehensive corporate compliance program to ensure adherence to all Centers for Medicare & Medicaid Services (CMS) requirements, as well as applicable federal, state, and internal regulations. This leader will serve as the primary compliance authority within the organization—promoting ethical conduct, mitigating regulatory risks, and ensuring business operations align with healthcare laws and best practices.
Key ResponsibilitiesRegulatory Compliance & Oversight
- Develop, implement, and maintain an enterprise-wide compliance program consistent with CMS Medicare Advantage (MA) and Part D regulations.
- Monitor ongoing compliance with federal and state healthcare laws, including CMS, HIPAA, OIG, and AHCA requirements.
- Serve as the point of contact for regulators during audits, data validation reviews, and compliance inquiries.
- Ensure accurate and timely submission of required reports, attestations, and certifications to oversight agencies.
Compliance Program Administration
- Design and oversee annual compliance training and education for employees, contractors, and first-tier, downstream, and related entities (FDRs).
- Conduct compliance risk assessments and develop annual work plans based on identified areas of exposure.
- Lead internal audits and monitoring activities to identify, investigate, and correct compliance issues.
- Manage documentation of investigations, findings, and corrective action plans to ensure timely resolution.
Collaboration & Leadership
- Provide compliance guidance and operational support across all business units, including Claims, Member Services, Provider Relations, Quality, Pharmacy, and Grievances & Appeals.
- Partner with department leaders to integrate compliance into daily workflows and operational decisions.
- Advise executive leadership and the Board Compliance Committee on emerging regulatory risks and mitigation strategies.
Reporting & Documentation
- Prepare and present compliance reports to executive leadership and the board.
- Maintain organized, detailed records of all compliance activities, risk assessments, and corrective actions.
- Ensure all compliance-related policies and procedures are reviewed, updated, and communicated regularly.
Qualifications
Education:
- Bachelor’s degree in Healthcare Administration, Business, Law, or a related field required.
- Master’s degree or Juris Doctor (JD) preferred.
- Certified in Healthcare Compliance (CHC) or equivalent certification strongly preferred.
Experience:
- 7–10 years of progressive experience in healthcare compliance, including 5 years in a leadership role within a Medicare Advantage or managed care organization.
- In-depth understanding of CMS Medicare Advantage and Part D regulations, as well as Medicaid and state agency oversight.
- Demonstrated success managing compliance audits, risk assessments, and remediation plans.
- Experience interacting directly with federal and state regulators.
Skills & Competencies:
- Strong analytical and investigative abilities with sound judgment.
- Excellent written and verbal communication skills, including the ability to explain complex regulatory requirements clearly.
- Proven leadership, integrity, and the ability to foster a culture of compliance and accountability.
- High attention to detail and commitment to ethical, transparent practices.
Work Environment
This is a full-time, onsite leadership position requiring close collaboration with internal teams and external regulatory agencies. Occasional travel may be required for audits, training, or compliance-related meetings.
Job Type: Full-time
Pay: $120,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Work Location: In person
Salary : $120,000