Senior Compliance Lead — Medicare, HIPAA & Vendors

Define Ventures; United States; Remote; USD 72,000 - 130,000; Full time

Benefits offered by this job

Medical, Dental, and Vision insurance

Employer paid Short-Term Disability

Employer Paid Long-Term Disability

Employer Paid Basic Life Insurance

Employee Assistance Program (EAP)

401(k) Program

Unlimited PTO

Paid holidays

Parental Leave

Job summary

evermore is seeking an experienced Senior Compliance Officer to lead our corporate compliance program and Medicare/Medicaid obligations. Reporting to the SVP of Legal, you will ensure HIPAA compliance and oversee vendors, business associates, and FDRs.

You will build scalable controls for a growing health-tech company, design internal training, draft policies, and coordinate audits and regulatory reporting across the organization.

Qualifications

• 8+ years of regulatory affairs/compliance experience within Medicare or Medicaid.
• 3+ years hands-on experience with FDR/vendor oversight and CMS or First-Tier Entity audits
• Bachelor's degree or equivalent preferred
• Working knowledge of 42 CFR Part 422/423 (Medicare Advantage and Part D regulations) and CMS 201
• Experience with a compliance management or GRC platform to support process automation and regulatory report tracking
• Data privacy experience is a plus, with some overlap with existing team members.
• AML/BSA experience is a plus; training can be provided internally.
• CHC (Certified in Healthcare Compliance) or CHPC preferred
• Demonstrated ability to independently own a compliance function with minimal support staff
• Act as a business enabler with a solutions-oriented approach to compliance.
• Strong written and verbal communication skills for interactions with regulators, auditors, and external partner

Responsibilities

• Oversee third-party and FDR oversight, due diligence, risk tiering, ongoing monitoring, and annual attestation.
• Partner with Legal on business associate agreements, delegation agreements, and required regulatory flow-down provisions in vendor agreements.
• Conduct exclusion and preclusion screening against the OIG LEIE and SAM.gov, the CMS Preclusion List, and applicable state Medicaid exclusion lists; automating the process with IT and confirming results monthly.
• Lead privacy and security incident response: intake, investigation, four-factor breach risk assessment, notification decisions, and reporting to plan clients under our delegation agreements; in cooperation with compliance colleagues across the company.
• Track incidents to closure, including root cause analysis and corrective action.
• Provide strong customer communication, expectation management, and know when to push back on client challenges.
• Draft and maintain compliance policies and procedures.
• Design and present compliance training in-house, developing internal capabilities rather than relying on outside consultants.
• Maintain effective lines of communication for compliance issue reporting, ensuring cross department understanding of key compliance risks and what each department must do to comply
• Conduct internal risk assessments and execute an annual monitoring and auditing work plan.
• Support delegation oversight audits by health plan clients and regulatory examinations by agencies.
• Own corrective action plans through validation and closure, whether self-identified or raised by a client or regulator.
• Prepare, review, and submit required regulatory reports and filings ahead of deadlines.
• Support evermore’s clients’ CMS filing obligations, including benefit specifications and supporting documentation.
• Review and distill program explainers into clear actionable guidance for internal teams
• Work at the speed of product, providing timely compliance input during product design to accelerate go-to-market timelines.

Job description

evermore is seeking an experienced Senior Compliance Officer to lead our corporate compliance program and Medicare/Medicaid obligations. Reporting to the SVP of Legal, you will ensure HIPAA compliance and oversee vendors, business associates, and FDRs.

You will build scalable controls for a growing health-tech company, design internal training, draft policies, and coordinate audits and regulatory reporting across the organization.