Medicare Compliance Program Lead

Job not on LinkedIn

🕒 July 10

🏄 California – Remote

🏄 California – Remote

💵 $94.6k - $119k / year

⏰ Full Time

🟠 Senior

🚔 Compliance

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SG Homecare

WebsiteLinkedInAll Job Openings

11 - 50 employees

💼 Consulting

📦 Logistics

🏭 Manufacturing

💰 Private Equity Round on 2022-06

Consulting • Logistics • Manufacturing

SG Homecare is California's leader in Durable Medical Equipment and Supplies, with over 20 years of experience in providing essential services like Respiratory Therapies, Custom and Power Mobility solutions, Orthotics and Prosthetics, and Enteral Nutrition. The company focuses on a patient-centric approach, working closely with healthcare providers and organizations to deliver customized care programs that enhance the patient experience. SG Homecare is dedicated to utilizing cutting-edge technology and maintaining strong communication channels to ensure high patient satisfaction and improved health outcomes.

📋 Description

• Administer the Medicare compliance program, ensuring adherence to CMS regulations, Medicare guidelines, and DMEPOS standards • Audit Medicare-related operational processes, including intake documentation, qualification, re-certification, and billing readiness • Establish and monitor internal controls and auditing systems to identify compliance risks and operational gaps • Serve as the primary compliance liaison across Intake, RCM, Customer Care, and Operations to improve Medicare workflows and resolve compliance-related issues. • Conduct routine audits of patient documentation, billing readiness, and reimbursement processes to ensure regulatory compliance • Interpret new and revised Medicare regulations and implement process updates to maintain compliance • Develop and maintain compliance policies, procedures, and documentation standards • Lead training initiatives and provide ongoing guidance to staff on Medicare documentation requirements, eligibility criteria, and billing standards • Provide guidance related to audits, denials, and compliance concerns • Prepare and present compliance reports, audit findings, and risk assessments to leadership • Identify opportunities for operational improvement and support strategic initiatives related to Medicare growth and compliance scalability • Provide guidance, onboarding support, and subject matter expertise to new team members as the department expands • Perform other duties as assigned

🎯 Requirements

• Bachelor’s degree preferred or equivalent combination of education and experience • Minimum 5 years of healthcare compliance experience, with strong Medicare, CMS, or DMEPOS experience required • Minimum 2 years of experience leading cross-functional compliance initiatives and operational workflows preferred • Strong knowledge of Medicare intake, billing, documentation requirements, and reimbursement processes • Demonstrated ability to interpret complex healthcare regulations and implement operationally effective solutions • Experience with internal auditing, compliance investigations, and corrective action planning • Advanced proficiency in Microsoft Office (Word, Excel, Outlook) and Adobe • Strong analytical, organizational, and problem-solving skills • Ability to manage multiple priorities in a fast-paced environment • Must be available to work evenings, weekends, and holidays if needed.