Job Description

Company Description

Solis Health Plans is a Medicare Advantage plan committed to meeting the needs of our members, providers, and partners. We pride ourselves on understanding the communities we serve and offering personalized, hands-on service. Solis is distinguished by our dedication to quality, efficiency, and collaboration. Our mission is to provide benefits and services that make a real difference in our members' lives. Welcome to healthcare that makes a difference. Welcome to Solis.

Role Description

This is a full-time, on-site role for a Director of Compliance located in Doral, FL. The Director of Compliance is responsible for overseeing and managing all aspects of the organization’s Compliance Program to ensure adherence to Centers for Medicare & Medicaid Services (CMS) regulations, state and federal laws, and internal policies. This leader will play a key role in maintaining an effective compliance culture across the organization, providing guidance and oversight to ensure Solis Medicare Advantage’s operations remain compliant, ethical, and aligned with regulatory expectations. 

Key Responsibilities

Regulatory Compliance & Oversight

• Develop, implement, and maintain the organization’s Compliance Program consistent with CMS requirements for Medicare Advantage (MA) and Part D plans.
• Monitor ongoing compliance with applicable federal and state laws, including CMS rules, HIPAA, and other healthcare regulations.
• Serve as the primary point of contact for CMS, OIG, AHCA, and other regulatory agencies during audits, data validation reviews, and compliance inquiries.
• Ensure accurate and timely submission of CMS required reporting, including compliance attestations and annual training certifications.

Compliance Program Administration

• Lead the design, delivery, and tracking of annual compliance training and education for all employees, contractors, and first-tier, downstream, and related entities (FDRs).
• Conduct internal compliance risk assessments and develop annual compliance work plans based on identified risk areas.
• Oversee internal audits and monitoring activities to detect, correct, and prevent compliance issues.
• Investigate potential compliance violations, document findings, and implement corrective action plans when necessary.

Collaboration & Guidance

• Provide compliance leadership and guidance to all business units, including Claims, Member Services, Provider Relations, Pharmacy, Quality, and Grievances & Appeals.
• Collaborate with operational leaders to integrate compliance considerations into daily business processes.
• Advise senior management and the Board of Directors on emerging compliance risks, regulatory updates, and mitigation strategies.

Reporting & Documentation

• Prepare and present regular compliance reports to executive leadership and the Board Compliance Committee.
• Maintain detailed and organized records of compliance activities, risk assessments, and audit findings.
• Ensure policies and procedures are reviewed and updated at least annually or as regulations change.

Qualifications

Education:

• Bachelor’s degree in Healthcare Administration, Business, Law, or a related field required.
• Master’s degree or Juris Doctor (JD) preferred.
• Certified in Healthcare Compliance (CHC) or equivalent certification strongly preferred.

Experience:

• Minimum of 7–10 years of progressive experience in healthcare compliance, with at least 5 years in a leadership role within a Medicare Advantage organization.
• Deep knowledge of CMS Medicare Advantage and Part D, Medicaid and AHCA regulations, including any statutory requirements applicable to MAPD Plans.
• Experience leading compliance audits, risk assessments, and corrective action implementation.
• Proven ability to interact effectively with federal and state regulators.

Skills & Competencies:

• Strong analytical, investigative, and problem-solving skills.
• Excellent written and verbal communication skills, with the ability to convey complex regulatory concepts clearly.
• Demonstrated leadership, integrity, and ability to influence organizational culture.
• Exceptional attention to detail and commitment to ethical standards.

Work Environment

This is a full-time, onsite leadership role requiring collaboration with internal departments and external partners. Occasional travel may be required for audits, training, or regulatory meetings.

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