Job Description

The Director of Quality Assurance/Compliance will oversee the day-to-day operations of the Quality Assurance/Compliance department. This role will work with the company’s legal resources to ensure all sales activities comply with regulatory requirements, which include guidelines set by the Centers for Medicare and Medicaid Services (CMS) as well as carrier partners.

Responsibilities include but are not limited to developing, monitoring, and enforcing compliance policies and procedures related to Medicare Advantage and Prescription Drug Plans (PDP) sales.

Duties and Responsibilities:

• Understands and stays up to date on Centers for Medicare & Medicaid Services (CMS) regulations
• Works directly with Health Plan Carriers to ensure compliance metrics and standards are held
• Serves as point-of-contact for external regulatory and enforcement actions (i.e., data requests, audits, etc.), CMS, and other applicable regulatory agencies.
• Improves the efficiency and quality of services through auditing and other methods
• Develops, implements, and enforces compliance programs based off CMS standards and regulatory changes
• Evaluates compliance training for all levels of staff to support an awareness and understanding of Medicare requirements and promote a culture of compliance accountability.
• Prepares reports and presentations required by senior leadership regarding Medicare compliance activities and sales floor activity.
• Monitors corrective actions and investigates allegations of improper conduct

Job Requirements:

• Bachelor’s degree in business, healthcare, law, or a related field.
• Minimum of 3-5 years of experience in healthcare compliance, particularly in Medicare sales compliance.
• Leadership and organizational skills.
• Strong knowledge of Medicare Advantage, Medicare Supplement, and PDP regulations
• Proficient with Centers for Medicare and Medicaid Services (CMS) guidelines
• Proficiency in Microsoft Office Suite
• Ability to effectively communicate with all levels of the organization.
• Effectively manages multiple projects and deadlines

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