Senior Vendor Compliance Program Manager

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience — a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.

About the role

In collaboration with the Senior Director of 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 to initiate corrective action and/or process improvement activities. Collaborate with the business to establish an oversight model that ensures all service delegates are managed in a compliant and timely way.

Responsibilities

• Manage vendor corrective action plan processes
• Conduct annual compliance risk assessment of vendors and use results to help craft the annual monitoring and auditing program
• Perform annual outreach to vendors to validate 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

Requirements

• Bachelor's Degree in a related field of study (required); Master's Degree in a related field of study (preferred). Experience can be substituted in lieu of a degree.
• Any certification in healthcare compliance (preferred)
• At least 8-10 years of program management experience
• At least 1-2 years of team leadership experience

Skills

• 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, 2-3 times per month.

Pay

$99,465.60 - $144,643.20 per year.

Schedule

• Scheduled weekly hours: 40
• Work shift: Day (United States of America)