Bridge Professional Services | Director of Quality ...

The Director of Quality AssuranceCompliance will oversee the day-to-day operations of the Quality AssuranceCompliance 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) regulationsWorks directly with Health Plan Carriers to ensure compliance metrics and standards are heldServes 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 methodsDevelops, implements, and enforces compliance programs based off CMS standards and regulatory changesEvaluates 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 conductJob 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 regulationsProficient with Centers for Medicare and Medicaid Services (CMS) guidelinesProficiency in Microsoft Office SuiteAbility to effectively communicate with all levels of the organization.Effectively manages multiple projects and deadlines

Created: 2025-01-11