HireDiversity

 

• Read and analyze all assigned CMS issued Medicare operational and compliance guidance to ensure all departments are alerted and necessary actions are taken to ensure compliance. Review and assess critical Medicare related implementation deadlines related to new or changing regulatory guidance. Identify key business leads for operational implementation and work directly with those resources during implementation efforts.
• Contribute to workgroup discussions and provide key insight into Medicare requirements that must be in place.
• Work with cross functional business areas to ensure that deadlines are on track and new/changing guidance is implemented.
• Provide weekly reporting on outstanding items in process and maintain ongoing log of status updates per implementation effort.
• Identify key process gaps during the implementation phase and escalate to management when necessary to ensure items are addressed.
• Maintain visibility of high risk compliance items at the senior leadership level throughout the implementation efforts.
• Act as liaison between Operational Compliance and Corporate Compliance when dealing with unclear regulatory requirements.
• Maintain system records of implementation efforts, summary of regulatory memos, and maintain ongoing list of deadlines to provide a clear line of sight on upcoming items that must be in place to ensure compliance.
• Participation in ad hoc projects related to quality reviews, audits, and other work efforts requiring compliance resource support.
• Review and provide recommendations on proposed compliance training plans specific to operations.
• Perform other duties as required.

• Bachelor’s degree or equivalent experience.
• Minimum 3-5 years health insurance and CMS regulatory compliance experience is required.
• Previous experience assessing compliance activities in Medicare operational areas (Enrollment Claims, etc.)
• Subject matter expert on the current CMS Part C and D manual chapters.
• Excellent organizational and interpersonal skills.
• Strong analytical and problem solving skills.
• Demonstrated verbal and written communication skills.
• Proficient with Microsoft Sharepoint and Microsoft Office applications.
• Proficient with standard PC applications.