Lead Compliance Program Manager

Who We Are Point
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Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point
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Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are.

We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are  Summary The Lead Compliance Program Manager will be responsible for development, implementation and management of significant and complex compliance programs, initiatives and projects associated with federal and state regulations for applicable lines of business (Corporate, Commercial, Medicare, Duals and/or Medicaid).

This work requires partnering with internal departments as well as external stakeholders including government regulators and auditors. The Lead Compliance Program Manager will be responsible for collaborating with leadership, teams and partnering departments to define and execute strategic compliance initiatives in order to accomplish successful compliance oversight and maintain an effective compliance program. The Lead Compliance Program Manager should make recommendations for change by performing risk analysis and by using basic analytical and problem-solving capabilities to support the recommendation.

Responsibilities at this level usually require facilitating cross-departmental meetings and negotiations with outside parties and regulators to explain and assess the impact. The Lead Compliance Program Manager will also interact directly and regularly with leadership within the department and within Point
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Health to accomplish successful compliance oversight and maintain an effective compliance program.

Job Description

Key Responsibilities /Duties – what you will be doing (top five):

Provide support in overall management of the compliance program key functions, including developing compliance workplans across all elements of an effective compliance program, including (but not limited to):
Risk Assessment;
Monitoring and Auditing;
Effective Communication;
Training and Education;
Policies and Procedures;
Vendor Oversight;
Issue correction and remediation.

Ensure ongoing compliance with established, revised, or new regulatory requirements that impact the organization, including delivery of benefits for members.

Oversee the compliance program through employee and leadership communications, coordination of policy development and ensure accurate and timely communication to all departments.

As applicable, conduct risk assessments, focused reviews, and/or audits to identify potential compliance issues and vulnerabilities. Effectively identify regulatory and compliance risks and provide plan of remediation.

Management of significant or complex regulatory audits to ensure timely completion of data and documentation collection, review, and submission. Perform review of regulatory audits results. Support development of responses. Track monitoring of responses and remediation actions.

Lead and/or manage projects and/or initiatives by representing regulatory and compliance expectations and requirements during planning and implementation phases. This may include coordinating issue resolution with relevant functional business areas, and leading and/or facilitating planning and review sessions.

Evaluate and analyze regulations and sub-regulatory guidance, interpret their significance and recommend and review policies to ensure compliance.

Manage tracking, investigation, and resolution of compliance oversight activities such as issue…