• Bachelor’s degree in Business Administration, Healthcare, or related field and/or equivalent experience

• Certified Internal Auditor (CIA), Certified Professional Coder (CPC) or Certified Risk Adjustment Coders (CRC), highly desired

• Minimum of 5 years of experience in Medicare Advantage and Part D Managed Care compliance role, required

• Minimum of 3 years of leadership experience building and leading a high-performing team, required

• Strong knowledge of CMS regulations, expectations, and best practices

• Deep understanding of audit processes, including Risk Adjustment Data Validation (RADV)and Pre-Delegation auditing, with proven experience using CMS guidelines and audit protocols

• Experience in participating in audits conducted by CMS and/or DMHC

• Working knowledge of Medicare Advantage and Prescription Drug product and the agencies that regulate the industry

• Ability to effectively communicate with various audiences and levels of leadership

• Ability to design and manage implementation of new processes and/or systems for new lines of business