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Associate Director - Medicare Compliance

| Greater NYC Area

By 2020, not only will Oscar operate in at least nine states, but we will also be offering Medicare Advantage-Prescription Drug Program (“MA-PD”) products. Oscar’s move into the MA-PD space will require that we develop a fully functional, Medicare Compliance Program that meets the standards set by the Centers for Medicare and Medicaid Services (“CMS”). The Associate Director, Medicare Compliance will assume primary responsibility for designing, establishing, and then operating this Medicare Compliance Program. Based either in Oscar’s Tempe office (the Oscar Health Hub) or in our New York headquarters, the Associate Director, Medicare Compliance will report to the Vice President, Compliance, forming an integral part of Oscar’s Compliance and MA teams.

In your first six weeks, you will:

  • Familiarize yourself with Oscar’s departments and functions, identifying current operational processes that can be leveraged for MA-PD compliance
  • Map all MA-PD compliance obligations set by CMS, ranking them by importance and operational risk

By the end of month 3, you will:

  • Develop a work plan for building a Medicare Compliance Program, for full implementation - ideally as of November 1, 2020
  • Beginning with the highest-risk areas, begin implementing this work plan across all of Oscar’s departments and functions
  • Identify and quantify additional resources that Oscar will need to deploy or acquire to ensure compliance with all CMS requirements

Afterwards and on an ongoing basis, you will:

  • Ensure that Oscar has a fully functional Medicare Compliance Program as of July 31, 2019 and afterward
  • Oversee and validate Oscar’s MA-PD submissions to CMS, including audit universes, Plan Reporting, and Medicare Data Validation content
  • Prepare Oscar for CMS and delegated audits and surveys, including One-Third Financial Audits, Full Program Audits, timeliness reviews, and Part D audits
  • Cooperate with Oscar’s financial, clinical, data, and technology functions to ensure that Part D Financial Reporting obligations are operationalized
  • Ensure that HPMS memos and all other CMS transmissions are digested, disseminated, and operationalized across Oscar’s functions
  • Establish productive relationships with Oscar’s regulators at CMS, including the assigned Account Manager
  • Anticipate Compliance Program needs at all Oscar locations, contributing to auditing and monitoring activity where necessary, and suggesting additions to the annual Compliance Work Plan
  • Chart a path forward to personal growth as a Compliance professional in a dynamic, fast-paced organization

Winning factors: What leads to success

We are looking for someone with a deep knowledge of MA-PD requirements who will promote a culture of compliance and ethics across all of Oscar’s operations.

Must-have qualifications and expertise include:

  • College degree
  • 7+ years’ experience in a MA-PD compliance setting, including managerial experience

Preferred qualifications include:

  • CHC, CCEC, or similar
  • Experience with HIPAA, data privacy, or data security processes
  • Experience in undergoing a full MA-PD program audit

We think you will be successful if...

  • You have experience directly interacting with CMS
  • You are a critical thinker who can distill complex concepts and regulatory requirements into easy to understand action items
  • You have acute attention to detail and always strive for perfection when writing formal documents.
  • You get things done, even if it’s crunch time
  • You enjoy working in a collaborative environment and working cross-functionally with all business areas within the organization
  • You are personable, self-starting and organized
  • You have passion for healthcare and a knack for making processes more systematic

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we work to cultivate an environment where exceptional people can be their most authentic selves and find both belonging and support. We're on a mission to change healthcare -- an experience made whole by your unique background and perspectives.

Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team ([email protected]) to make the need for an accommodation known.

Pay Transparency Policy: Oscar's Pay Transparency Policy ensures that you won't be discharged or discriminated against based on whether you've inquired about, discussed, or disclosed your pay. Read the full policy here.

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