USCAN Compliance Monitoring Lead Specialist
GE HealthCare
Job Level
Senior
About the role
- Oversee company-wide compliance initiatives related to program administration, focusing on network integrity, quality control, and regulatory adherence (particularly CMS requirements)
- Design and maintain a comprehensive compliance framework aligned with CMS, HIPAA, and internal standards
- Monitor federal and state regulatory changes and translate them into internal policies
- Ensure network partners meet contractual and regulatory obligations; conduct audits of network sufficiency, accessibility, and quality
- Lead CMS audit preparation and response, including CAP submissions and validation audits; maintain CMS documentation and encounter data reporting
- Develop network quality control protocols, identify and mitigate compliance risks
- Draft and enforce compliance policies; partner with Training & Development to deliver role-specific compliance education
- Serve as primary liaison for internal and external audits; provide legal guidance on employment-related matters
Requirements
- Bachelor’s degree in Healthcare Administration, Public Policy, or related field (Master’s preferred)
- 7+ years of experience in healthcare compliance, with direct exposure to CMS regulations and Medicare Advantage programs
- Proven track record in leading compliance initiatives across multi-stakeholder environments
- Strong understanding of network governance, provider contracting, and quality assurance protocols
- Experience with audit coordination and CAP management
- Excellent communication and policy writing skills
