Medicare Advantage Compliance Specialist

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $85k - $90k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🚔 Compliance

👻 Ghost score 4%

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📋 Description

• Monitor and interpret CMS regulations, sub-regulatory guidance, HPMS memos, and CMS transmittals. • Assess operational impacts and ensure timely implementation of required changes for Medicare Advantage and Managed Medicaid plans. • Coordinate root cause analyses (RCA) and corrective action plans (CAPs), ensuring timely resolution and effective implementation through documented follow-up. • Analyze monitoring data to identify trends, anomalies, or potential non-compliance and provide actionable recommendations. • Create and maintain tracking tools, reports, and dashboards for compliance monitoring and remediation follow-up. • Assign, track, and monitor completion of compliance, Fraud, Waste & Abuse (FWA), and HIPAA privacy and security training. • Conduct monthly OIG and GSA exclusion-list screening for employees and vendors; investigate and escalate positive matches. • Support development and maintenance of compliance policies, procedures, and related documentation. • Maintain knowledge of federal and state regulations, including CMS Medicare Advantage and Medicaid Managed Care rules, HIPAA, and state-specific health plan requirements. • Participate in compliance risk assessments, policy and procedure development, monitoring work plan development, Compliance Committee reporting, annual Medicare Parts C & D reporting, external audit readiness, and audit support. • Meet regularly with the Chief Compliance Officer to set priorities, align work efforts, and discuss issues and improvement opportunities.

🎯 Requirements

• 3-4 years of experience in healthcare compliance with specific experience in Medicare Advantage regulatory monitoring. • Bachelor’s Degree from an accredited university or equivalent experience. • Strong understanding of applicable laws, regulations, and standards impacting health plans, including CMS, Medicaid, HIPAA, and OIG. • Experience managing Root Cause Analyses (RCAs) and Corrective Action Plans (CAPs). • Familiarity with exclusion screening processes (OIG/GSA) and vendor oversight. • Proficient writing expertise; ability to write effectively and succinctly, convey information clearly and concisely without ambiguity and in a logical coherent flow. • Ability to analyze data and facts and draw logical conclusions. • Sound decision-making skills and meticulous attention to detail. • Demonstrated ability to perform at a high level in a fast-paced, demanding compliance environment. • Strong, self-directed performer capable of managing complex responsibilities with consistency and precision. • High degree of discretion in dealing with confidentiality of all compliance-related matters. • Certification in Healthcare Compliance, such as CHC or CCEP.

🏖️ Benefits

• 100% remote work culture with the ability to work within the U.S. • Comprehensive health, dental and vision coverage for you and your family. • 5 weeks paid vacation and holiday time off • Traditional and ROTH 401k with company match • Company-paid life insurance, AD&D and long-term disability coverage • Tuition reimbursement • Parental leave • Employee assistance with resources for mental health, financial wellness and more.

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