Medicare Compliance Program Lead

Job not on LinkedIn

🔥 6 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $94.6k - $119k / year

⏰ Full Time

🟠 Senior

🚔 Compliance

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SG Homecare

WebsiteLinkedInAll Job Openings

11 - 50 employees

💰 Private Equity Round on 2022-06

We are California's Leader in Durable Medical Equipment & Supplies

📋 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.