• Experience in regulatory compliance roles for US healthcare with deep expertise in Medicare Advantage programs.
• Experience participating in CMS audits for Medicare advantage
• HEDIS and STAR rating experience
• Medicare related regulations, FDR oversight and audit requirements, HIPAA
• Strong understanding of healthcare payer operations.
• Experience in compliance program administration including risk assessments, policy creation, training, monitoring and reporting, audits and investigations
• Experience in developing HIPAA compliant applications/ operational processes.
• Experience working in cloud technologies and implementing controls for BPaaS scenarios
• Excellent communication, presentation, and interpersonal skills
• Ability to influence cross functional teams without direct authority.
• Solid analytical and risk-based decision-making skills.