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Director, Medicare Compliance at INTEGRA MLTC, INC.

Posted in Management 30+ days ago.

This job brought to you by eQuest

Type: Full-Time
Location: Lake Success, New York

Job Description:

General Purpose/Scope:

The Director, Medicare Compliance is a key member of Integra's Corporate Compliance team reporting to the Chief Compliance and Privacy Officer working alongside compliance department staff and members of Integra management. The Director is responsible for Medicare compliance oversight and is accountable for a broad range of critical Medicare compliance activities. Accountable activities include ongoing program management, improvement, investigations, policy development, creation of reports and presentations for the Compliance Committee, and collaboration with internal business partners and external individuals, including delegated entities, CMS Account Manager and other CMS regulators. The Director, Medicare Compliance will be responsible for building, leading and mentoring a team of compliance professional(s).

Responsibilities include:

Serve as a subject matter expert on Medicare compliance matters including answering interdepartmental questions concerning various Medicare topics while partnering with other business areas to integrate and deliver on Medicare compliance requirements.
Collaborate with the Compliance Department to develop and conduct annual risk assessments and audit work plans for the Medicare line of business.
Oversee internal and external auditing while monitoring and advising on relevant Medicare compliance requirements.
Continually monitor and improve internal and external audit and monitoring processes to ensure that the organization, as well as vendors, are compliant with applicable laws.
Actively involved in daily operations to meet deadlines or resolve problems, including managing the implementation of corrective action plans for all known Medicare compliance deficiencies.
Identify and present issues potentially impacting the Medicare lines of business to the attention of the appropriate business leaders.
Manage the planning, scheduling and implementation of procedural changes required for meeting organizational compliance program effectiveness.
Develop and maintain effective education and communication standards for Medicare Compliance program effectiveness.
Ensure identification, engagement, and management of relevant stakeholders across the organization during the development of Medicare compliance Policies & Procedures and Standard Operating Procedures are developed and meet regulations.
Act as an interdepartmental liaison regarding regulatory and legislative activity related to the Company's Medicare products while raising awareness of various Compliance topics.
Create reports and presentations required by the Compliance Committee regarding Medicare Compliance activities
Lead compliance investigations into alleged Medicare violations of rules, policies, procedures, laws or regulations and implements necessary corrective actions.
Responsible for strategic and proactive hiring, performance management and coaching/mentoring/training to enhance professional development.
Perform other duties as assigned.


Bachelor's degree preferably in healthcare or business administration
Master's degree preferred
7+ years of Medicare health plan experience, preferably in government programs
3+ years compliance experience in healthcare organizations and knowledge with third party payer rules and regulations, and federal and state laws regarding healthcare
2+ years of leadership experience, including hiring, developing and mentoring a team.


Strong oral and written communication skills, as well as excellent presentation skills
Ability to manage competing priorities and deadlines that are subject to change frequently
Demonstrated knowledge of Medicare compliance practices and regulations
Strong facilitation, collaboration and interpersonal skills with the ability to build productive cross-functional partnerships to drive business results
Excellent problem solving, analytical and critical thinking skills
Must be proficient with MS Office including Word, Outlook, Excel and PowerPoint
Must have the ability to make sound and evaluative judgements
Outstanding planning and organizational skills
Proven self-starter with the ability to lead multiple projects in a fast-paced environment
Ability to manage multiple projects
Strong leadership and mentoring skills


Certification in Healthcare Compliance (CHC) from the Compliance Certification Board (CCB) preferred

Integra is an Equal Opportunity Employer and prohibits discrimination or harassment based on any characteristics protected by the laws or regulations in the locations where we operate.

If this opportunity sounds exciting and challenging to you, please click "Apply" now!