Director, Medicare Compliance

    • New York, NY

The Director of Medicare Compliance reports to the Chief Compliance Officer and works with other compliance personnel and members of management. The Director of Medicare Compliance is accountable for a broad range of critical compliance activities, including ongoing program management, improvement, investigations, policy development, facilitating compliance committee forums, focused on Medicare compliance oversight, liaison with internal and external customers, and reporting to senior leadership.

Serves as subject matter expert on Medicare compliance matters; answer on Medicare compliance matters; answer questions from internal departments about various topics and participates on teams that need to integrate or deliver compliance requirements.

  • Collaborates with the Compliance Department to develop and conduct annual risk assessment for the Medicare line of business. 
  • Actively involved in daily operations to meet schedules or resolve problems, including implementation of policies to ensure that company priorities, and identified corrective action plans.
  • The Director of Medicare Compliance manages planning, scheduling and procedural changes.  In addition, the incumbent oversees internal and external auditing and monitoring and advises on relevant Medicare compliance requirements.  
  • The Director of Medicare Compliance also identifies and presents issues that may impact the Medicare business to the attention of the appropriate business leaders.
  • Continually monitors and improves internal and external audit and monitoring processes to ensure that the organization, as well as vendors, is compliant with applicable laws.
  • Develops and maintains effective communication.

Minimum Qualifications
  • Bachelor's degree in accounting, business, or healthcare administration
  • Must have 10 years of related experience within Medicare Compliance
  • Proven critical thinking, analysis and problem solving skills
  • Strong oral and written communication and presentation skills
  • Flexible, creative and adaptable in dealing with problems

Preferred Qualifications
  • Certification in health care compliance (CHC)
  • Master's degree in accounting, business, or healthcare administration

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law, and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

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As New York’s largest not-for-profit health insurer, Healthfirst offers high-quality, market-leading products to nearly 1.4 million members.

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