Compliance Examiner – Medicare

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Our client provides a range of health solutions for rural communities. With new projects on the horizon, they are hiring a Compliance Examiner to ensure that Medicare benefits are complying with CMS and company guidelines.

The Compliance Examiner will be responsible for performing periodic audits, continuously improve policies, and ensure Medicare benefits are compliant with current regulatory standards. To be successful in the role, this individual should have a strong Medicare Advantage background with proven experience implementing policies and procedures.

This Role Offers:

• Competitive base salary plus comprehensive benefits, including medical/dental/vision, 401(K), and more.
• Stable company with over seven decades of experience.
• Tight-knit culture focused on taking care of their employees.
• Ample opportunities for growth and career advancement.
• High employee tenure with low red tape culture. They hire professionals and trust their expertise, giving them room to make tangible impacts.

Focus:

• Ensure implementation and compliance of all Medicare regulatory policies and practices.
• Provide reports, procedures, plans and compliance monitoring guidelines to the team.
• Develop and implement a compliance annual risk and readiness assessment.
• Document member enrollment and disenrollment in CMS system. Prepare data reports for senior leadership.
• Make outbound calls to health care providers, members, etc. to verify claims and coverage.
• Conduct periodic compliance audits and draw analyses based on results.
• Stay abreast with changes to CMS and federal requirements along with recommending actions required to maintain compliance.

Skill Set:

• 2-5+ years of experience working in Medicare compliance roles.
• High School Diploma required; Higher education preferred.
• Thorough understanding of and experience with compliance monitoring and auditing.
• Prior success implementing compliance policies and procedures.
• Proven ability to manage issues by finding solutions and communicating changes effectively.
• Strong communication skills and ability to develop creative solutions to business challenges.
• Background in a fast-paced environment with proven ability to work well under pressure.