Medicare Compliance Manager

Valor Health Plan; North Canton (OH); On-site; USD 90,000 - 120,000; Full time

Job summary

Valor Health Plan is seeking a MAPD Compliance Manager to support the Compliance Officer in administering the Medicare Compliance Program. The role collaborates with operational departments to ensure Medicare Advantage and Part D compliance and regulatory reporting.

The position covers audit preparation, monitoring CMS updates, maintaining documentation, and tracking action plans. Strong organizational and communication skills are essential.

Qualifications

• Bachelor's degree in healthcare administration, business, compliance, or related field; equivalent experience may be considered.
• 5–8 years of healthcare, Medicare Advantage, Part D, compliance, auditing, or related experience.
• Knowledge of Medicare Advantage and Part D requirements preferred.
• Strong organizational, analytical, and communication skills.
• Excellent attention to detail and ability to manage multiple deadlines.
• Proficiency with Microsoft Office applications.

Responsibilities

• Assist Compliance Officer with administration of the Medicare Compliance Program and annual compliance work plan.
• Monitor CMS communications and regulatory updates and communicate applicable changes to the Compliance Officer and impacted departments.
• Assist with compliance audits, monitoring activities, testing, and preparation of audit documentation.
• Maintain compliance audit files, tracking logs, and supporting documentation.
• Assist with CMS audit preparation, including gathering and organizing requested documentation.
• Track compliance findings, corrective actions, and follow‑up activities.
• Assist with delegated entity and vendor compliance monitoring and documentation.
• Support review and maintenance of Medicare compliance policies and procedures.
• Assist with compliance training coordination and tracking.
• Prepare routine compliance reports, summaries, and materials for the Compliance Officer and Compliance Committee.
• Identify potential compliance concerns and appropriately escalated issues to the Compliance Officer.
• Maintain confidentiality and ensure compliance documentation is organized and readily accessible.

Skills

Regulatory compliance

Auditing

Communication

Organizational skills

Attention to detail

Education

Bachelor's degree

Tools

Microsoft Office

Job description

The MAPD Compliance Manager supports the Compliance Officer in the administration and day-to-day activities of the Medicare Compliance Program. The position assists with regulatory monitoring, auditing and monitoring activities, compliance documentation, reporting, and follow-up of compliance-related issues.

The Compliance Manager works collaboratively with operational departments and delegated entities to support compliance with Medicare Advantage and Part D requirements and reports directly to the Compliance Officer.

• Assist the Compliance Officer with administration of the Medicare Compliance Program and annual compliance work plan.
• Monitor CMS communications and regulatory updates and communicate applicable changes to the Compliance Officer and impacted departments.
• Assist with compliance audits, monitoring activities, testing, and preparation of audit documentation.
• Maintain compliance audit files, tracking logs, and supporting documentation.
• Assist with CMS audit preparation, including gathering and organizing requested documentation.
• Track compliance findings, corrective actions, and follow‑up activities.
• Assist with delegated entity and vendor compliance monitoring and documentation.
• Support review and maintenance of Medicare compliance policies and procedures.
• Assist with compliance training coordination and tracking.
• Prepare routine compliance reports, summaries, and materials for the Compliance Officer and Compliance Committee.
• Identify potential compliance concerns and appropriately escalated issues to the Compliance Officer.
• Maintain confidentiality and ensure compliance documentation is organized and readily accessible.

Qualifications

• Bachelor's degree in healthcare administration, business, compliance, or a related field; equivalent experience may be considered.
• 5–8 years of healthcare, Medicare Advantage, Part D, compliance, auditing, or related experience.
• Knowledge of Medicare Advantage and Part D requirements preferred.
• Strong organizational, analytical, and communication skills.
• Excellent attention to detail and ability to manage multiple deadlines.
• Proficiency with Microsoft Office applications.

Preferred Experience

• Medicare Advantage or Part D health plan experience.
• Experience with CMS audits, compliance monitoring, or corrective action tracking.
• Experience with Department of Insurance oversight and regulatory reporting.
• Experience with delegated entity or vendor oversight.
• Experience with Special Needs Plans (SNPs), particularly I-SNPs.