Medicare Compliance Analyst, Claims

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November 7

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biBerk Business Insurance

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Insurance • Cybersecurity • B2B

biBerk Business Insurance is a provider of tailored business insurance solutions, designed to safeguard businesses from various risks and uncertainties. The company focuses on delivering comprehensive insurance products that cater to the specific needs of different enterprises, ensuring that their operations are protected from potential disruptions and financial losses.

51 - 200 employees

🔒 Cybersecurity

🤝 B2B

📋 Description

• Ensure compliance with Medicare regulations, including CMS guidelines and HIPAA privacy standards. • Monitor and interpret state and federal legislation affecting Medicare claims and reporting. • Maintain up-to-date documentation and reference materials related to regulatory requirements. • Review and analyze Claims data for accuracy, completeness and compliance for Medicare Section 111 reporting. • Identify and resolve discrepancies in claims submissions, including coding. • Prepare and submit reports for regulatory filings and internal compliance tracking. • Respond to inquiries from state and federal agencies regarding claims and compliance matters. • Maintain detailed records of compliance activities, audits, and corrective actions related to Medicare reporting. • Work closely with Claims business stakeholders, IT, legal and Compliance to ensure alignment on Medicare compliance initiatives. • Support Claims BA teams in integrating compliance requirements into system updates and workflow. • Stay informed on emerging regulations and industry best practices. • Additional Claims compliance duties as assigned.

🎯 Requirements

• Bachelor’s degree required • Ability to assess processes to identify key areas of risk and implement resolution strategies and best practices • Ability to interact with multiple levels of staff and state regulatory authorities • Strong analytical, research, organizational, critical thinking, and project management skills and the ability to apply them in a manner that protects the company’s interest while also providing the most amicable solution possible. • 2+ years of insurance Claims experience in all commercial lines with workers’ compensation experience required • Familiarity with Medicare Secondary Payer (MSP) rules, CMS guidelines, including Section 111 reporting. • Has a solid understanding of Ongoing Medicare Responsibility for Medicals (ORM) and Total Payment Obligation to claimant (TPOC) reporting requirements.

🏖️ Benefits

• Medical (PPO/HDHP), vision, disability, and life insurance. • Enhanced dental plan with orthodontia coverage in addition to a standard plan. • Generous PTO plan for all benefit-time eligible employees. • Paid company holidays and 4 floating holidays. • Paid parental leave. • Employee Retirement Savings Plan/401(k) with company match and immediate vesting. • Education Assistance Program that offers 100% upfront tuition reimbursement after 6 months of service for approved degree programs. • Service Recognition Program that provides a monetary award to be used toward a vacation every 5 years of employment. • Wellness Initiatives that include Fitness Center and Weight Watchers Reimbursement programs. • Voluntary benefits that include accident, critical illness, and hospital indemnity. • Employee discount and rewards program on travel, tickets, electronics, home, and more.