MassHealth provides comprehensive health coverage to more than 2 million residents across Massachusetts and manages an annual budget exceeding $23 billion. The Chief Compliance Officer serves as an essential executive leader dedicated to safeguarding the integrity and sustainability of this impactful program. This role offers a unique opportunity to shape compliance strategy at a statewide level while advancing health equity and ensuring adherence to complex federal and state regulatory requirements. Working closely with senior MassHealth leadership and the EOHHS General Counsel’s Office, the Chief Compliance Officer guides the development and enhancement of compliance frameworks, internal controls, and remediation strategies that support program integrity and operational excellence.
In this influential position, the selected candidate provides executive-level oversight of external audit engagement and response, including coordination with key oversight entities such as the Centers for Medicare & Medicaid Services, Inspectors General, the State Auditor, the Government Accountability Office, and the State Comptroller. The role supervises the Deputy Director responsible for audit coordination and collaborates closely with the Director of Fraud Investigations and Enforcement Coordination to align compliance priorities with fraud enforcement activities. Serving as a trusted advisor to leadership, the Chief Compliance Officer offers strategic recommendations on compliance risk, policy and process improvements, and corrective action planning while fostering strong relationships with internal and external stakeholders, including the Attorney General’s Medicaid Fraud Division. This position is ideal for a mission-driven leader seeking to influence policy, strengthen accountability, and make a lasting impact on the delivery of health care services throughout the Commonwealth.
Duties and Responsibilities (these duties are a general summary and not all inclusive):
- · Serve as the MassHealth Chief Compliance Officer, providing executive leadership and strategic direction for compliance, program integrity, and risk management initiatives across the program.
- · Oversee the development, implementation, and continuous improvement of compliance policies, procedures, and internal controls to ensure adherence to complex federal and state regulatory requirements.
- · Guide the alignment of compliance, audit response, and remediation activities to effectively identify, mitigate, and address program risks while promoting program sustainability.
- · Provide executive-level oversight of MassHealth’s response to external audits, ensuring coordinated engagement with oversight entities such as the Centers for Medicare & Medicaid Services (CMS), Inspectors General, the State Auditor, the Government Accountability Office (GAO), and the State Comptroller.
- · Supervise and support the Deputy Director responsible for audit coordination, ensuring timely, strategic, and consistent responses to audit findings and corrective action requirements.
- · Collaborate closely with the Director of Fraud Investigations and Enforcement Coordination to align compliance priorities with fraud detection, referral, and enforcement strategies.
- · Advise MassHealth leadership and the EOHHS General Counsel’s Office on compliance risks, corrective action planning, policy considerations, and system improvements to strengthen program integrity.
- · Design and implement enhanced information-sharing, coordination, and accountability processes that support effective remediation and compliance monitoring across MassHealth.
- · Lead cross-functional initiatives and special projects that address urgent agency priorities, strengthen compliance frameworks, and support strategic organizational objectives.
- · Develop and present clear, concise, and actionable reports and recommendations for executive leadership, policymakers, and external stakeholders, including responses to inquiries from the Governor, legislators, and other interested parties.
- · Recommend and support business process improvements, change management strategies, and the development of reporting systems that enhance data utilization for program oversight and decision-making.
- · Foster and maintain strong relationships with internal stakeholders and external partners, including the Attorney General’s Medicaid Fraud Division and the EOHHS Chief Compliance Officer, ensuring consistent and compliant communication across all program integrity activities.
Preferred Qualifications:
- · Significant senior-level experience in healthcare compliance, Medicaid or Medicare programs, program integrity, or regulatory oversight within a complex public or private sector organization.
- · Demonstrated knowledge of federal and state healthcare regulations, including Medicaid requirements, Centers for Medicare & Medicaid Services (CMS) guidance, and audit frameworks such as PERM and Single State Audits.
- · Proven experience managing or overseeing responses to external audits and investigations conducted by entities such as CMS, Offices of Inspector General, the Government Accountability Office (GAO), or state oversight bodies.
- · Experience leading multidisciplinary teams and influencing executive-level decision-making within large, matrixed organizations.
- · Strong understanding of healthcare law, regulatory compliance, and policy development, with the ability to interpret complex statutory and regulatory requirements and translate them into operational strategies.
- · Experience collaborating with or supporting fraud investigation and enforcement activities, including engagement with law enforcement or Medicaid Fraud Control Units.
- · Demonstrated ability to build and sustain effective relationships with internal leadership, government agencies, and external partners while navigating sensitive and high-profile issues.
- · Experience leveraging data analytics and reporting systems to monitor compliance, assess risk, and inform strategic planning and corrective action initiatives.
- · Exceptional written and verbal communication skills, including experience preparing executive briefings, policy recommendations, and presentations for senior leadership, policymakers, and oversight entities.
- · Proficient with Microsoft Office applications including Excel, Word, Outlook, PowerPoint, and Teams.
ADA Reasonable Accommodation:
If you require a reasonable accommodation with the application/interview process, please contact us at: EOHHS Candidate ADA Requests
For questions about this requisition, please contact Employment and Staffing Customer Service at 1-800-510-4122, option 4.
Questions or issues regarding access/login credentials to MassCareers, please contact the Mass HR ESC at 617-979-8500.
Qualifications
MINIMUM ENTRANCE REQUIREMENTS:
Applicants must have at least (A) six (6) years of full-time or, equivalent part-time, professional, administrative, supervisory, or managerial experience in business administration, business management, public administration, public management, clinical administration or clinical management of which (B) at least two (2) years must have been in a supervisory or managerial capacity or (C) any equivalent combination of the required experience and substitutions below.
Substitutions:
I. A certificate in a relevant or related field may be substituted for one (1) year of the required (A) experience.
II. A Bachelor's degree in a related field may be substituted for two (2) years of the required (A) experience.
III. A Graduate degree in a related field may be substituted for three (3) years of the required (A) experience.
IV. A Doctorate degree in a related field may be substituted for four (4) years of the required (A) experience.
Salary placement is determined by a combination of factors, including the candidate’s years of directly related experience and education, and alignment with our internal compensation structure as set forth by the Human Resources Division’s Hiring Guidelines. For all bargaining unit positions (non-management), compensation is subject to the salary provisions outlined in the applicable collective bargaining agreement and will apply to placement within the appropriate salary range.
Comprehensive Benefits
When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future.
Want the specifics? Explore our Employee Benefits and Rewards!
An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.
The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don't meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role.
15-25 years96
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Job Description
Download ResumeMassHealth provides comprehensive health coverage to more than 2 million residents across Massachusetts and manages an annual budget exceeding $23 billion. The Chief Compliance Officer serves as an essential executive leader dedicated to safeguarding the integrity and sustainability of this impactful program. This role offers a unique opportunity to shape compliance strategy at a statewide level while advancing health equity and ensuring adherence to complex federal and state regulatory requirements. Working closely with senior MassHealth leadership and the EOHHS General Counsel’s Office, the Chief Compliance Officer guides the development and enhancement of compliance frameworks, internal controls, and remediation strategies that support program integrity and operational excellence.
In this influential position, the selected candidate provides executive-level oversight of external audit engagement and response, including coordination with key oversight entities such as the Centers for Medicare & Medicaid Services, Inspectors General, the State Auditor, the Government Accountability Office, and the State Comptroller. The role supervises the Deputy Director responsible for audit coordination and collaborates closely with the Director of Fraud Investigations and Enforcement Coordination to align compliance priorities with fraud enforcement activities. Serving as a trusted advisor to leadership, the Chief Compliance Officer offers strategic recommendations on compliance risk, policy and process improvements, and corrective action planning while fostering strong relationships with internal and external stakeholders, including the Attorney General’s Medicaid Fraud Division. This position is ideal for a mission-driven leader seeking to influence policy, strengthen accountability, and make a lasting impact on the delivery of health care services throughout the Commonwealth.
Duties and Responsibilities (these duties are a general summary and not all inclusive):
- · Serve as the MassHealth Chief Compliance Officer, providing executive leadership and strategic direction for compliance, program integrity, and risk management initiatives across the program.
- · Oversee the development, implementation, and continuous improvement of compliance policies, procedures, and internal controls to ensure adherence to complex federal and state regulatory requirements.
- · Guide the alignment of compliance, audit response, and remediation activities to effectively identify, mitigate, and address program risks while promoting program sustainability.
- · Provide executive-level oversight of MassHealth’s response to external audits, ensuring coordinated engagement with oversight entities such as the Centers for Medicare & Medicaid Services (CMS), Inspectors General, the State Auditor, the Government Accountability Office (GAO), and the State Comptroller.
- · Supervise and support the Deputy Director responsible for audit coordination, ensuring timely, strategic, and consistent responses to audit findings and corrective action requirements.
- · Collaborate closely with the Director of Fraud Investigations and Enforcement Coordination to align compliance priorities with fraud detection, referral, and enforcement strategies.
- · Advise MassHealth leadership and the EOHHS General Counsel’s Office on compliance risks, corrective action planning, policy considerations, and system improvements to strengthen program integrity.
- · Design and implement enhanced information-sharing, coordination, and accountability processes that support effective remediation and compliance monitoring across MassHealth.
- · Lead cross-functional initiatives and special projects that address urgent agency priorities, strengthen compliance frameworks, and support strategic organizational objectives.
- · Develop and present clear, concise, and actionable reports and recommendations for executive leadership, policymakers, and external stakeholders, including responses to inquiries from the Governor, legislators, and other interested parties.
- · Recommend and support business process improvements, change management strategies, and the development of reporting systems that enhance data utilization for program oversight and decision-making.
- · Foster and maintain strong relationships with internal stakeholders and external partners, including the Attorney General’s Medicaid Fraud Division and the EOHHS Chief Compliance Officer, ensuring consistent and compliant communication across all program integrity activities.
Preferred Qualifications:
- · Significant senior-level experience in healthcare compliance, Medicaid or Medicare programs, program integrity, or regulatory oversight within a complex public or private sector organization.
- · Demonstrated knowledge of federal and state healthcare regulations, including Medicaid requirements, Centers for Medicare & Medicaid Services (CMS) guidance, and audit frameworks such as PERM and Single State Audits.
- · Proven experience managing or overseeing responses to external audits and investigations conducted by entities such as CMS, Offices of Inspector General, the Government Accountability Office (GAO), or state oversight bodies.
- · Experience leading multidisciplinary teams and influencing executive-level decision-making within large, matrixed organizations.
- · Strong understanding of healthcare law, regulatory compliance, and policy development, with the ability to interpret complex statutory and regulatory requirements and translate them into operational strategies.
- · Experience collaborating with or supporting fraud investigation and enforcement activities, including engagement with law enforcement or Medicaid Fraud Control Units.
- · Demonstrated ability to build and sustain effective relationships with internal leadership, government agencies, and external partners while navigating sensitive and high-profile issues.
- · Experience leveraging data analytics and reporting systems to monitor compliance, assess risk, and inform strategic planning and corrective action initiatives.
- · Exceptional written and verbal communication skills, including experience preparing executive briefings, policy recommendations, and presentations for senior leadership, policymakers, and oversight entities.
- · Proficient with Microsoft Office applications including Excel, Word, Outlook, PowerPoint, and Teams.
ADA Reasonable Accommodation:
If you require a reasonable accommodation with the application/interview process, please contact us at: EOHHS Candidate ADA Requests
For questions about this requisition, please contact Employment and Staffing Customer Service at 1-800-510-4122, option 4.
Questions or issues regarding access/login credentials to MassCareers, please contact the Mass HR ESC at 617-979-8500.
Qualifications
MINIMUM ENTRANCE REQUIREMENTS:
Applicants must have at least (A) six (6) years of full-time or, equivalent part-time, professional, administrative, supervisory, or managerial experience in business administration, business management, public administration, public management, clinical administration or clinical management of which (B) at least two (2) years must have been in a supervisory or managerial capacity or (C) any equivalent combination of the required experience and substitutions below.
Substitutions:
I. A certificate in a relevant or related field may be substituted for one (1) year of the required (A) experience.
II. A Bachelor's degree in a related field may be substituted for two (2) years of the required (A) experience.
III. A Graduate degree in a related field may be substituted for three (3) years of the required (A) experience.
IV. A Doctorate degree in a related field may be substituted for four (4) years of the required (A) experience.
Salary placement is determined by a combination of factors, including the candidate’s years of directly related experience and education, and alignment with our internal compensation structure as set forth by the Human Resources Division’s Hiring Guidelines. For all bargaining unit positions (non-management), compensation is subject to the salary provisions outlined in the applicable collective bargaining agreement and will apply to placement within the appropriate salary range.
Comprehensive Benefits
When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future.
Want the specifics? Explore our Employee Benefits and Rewards!
An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.
The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don't meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role.