Possessing a deep knowledge of Medicare regulations, the Medicare Compliance Specialist will assist in maintaining an internal compliance program; guide special projects; provide regulatory interpretation; perform compliance reporting; and develop and implement compliance auditing and monitoring programs. The Medicare Compliance Specialist is responsible for conducting audits of departments involved in the delivery, administration, and billing of Healthcare services in compliance with CMS, Medicare Advantage, Medicaid, and company standards with an emphasis on detecting, preventing, and correcting fraud, waste, and abuse.
This is a remote role - prefer that candidate hired resides in one of our current markets (Minnesota, Wisconsin, Florida).
- Create and maintain databases and spreadsheets related to regulatory submissions and reporting, licensing, contracts, policies, procedures, laws and regulations
- Understand and prioritize timeframes associated with CMS, Medicare Advantage (MA), federal and state regulatory guidance
- Under leadership’s guidance, communicate with regulatory agencies to clarify requirements, address reporting and filing issues
- Communicate state and federal requirements to internal and external clients
- Investigate regulatory inquiries as assigned and provide accurate information to all business stakeholders to provide an increased awareness of applicable regulations as it pertains to the inquiry
- Review and monitor new and updated laws and regulations, disseminating findings to key stakeholders accordingly. Participate on various compliance subcommittees and workgroups
- Perform periodic compliance audits, risk assessments and conducts related ongoing compliance monitoring activities under guidance of VP of Corporate Compliance.
- Prepare analyses/reports based on audit results, including recommendations for corrective action; maintain records of audits and follow-up of corrective actions
- Assist management in developing compliance audit instruments and protocols
- Respond to external requests for information required by the organization for its regulatory filings; respond to inquiries from state and federal regulatory agencies
- Assist in developing, producing and conducting compliance training programs
- Other duties as assigned
- Minimum 3 years’ related experience in Medicare/Medicare Advantage regulatory compliance.
- Bachelor’s degree required or equivalent experience
- Relevant Healthcare Industry Certification Preferred (CHC, RHIT, RHIA, CPMA, CPCO, etc)
- Working knowledge of related federal and state laws and regulations and CMS compliance
- Demonstrated understanding of CMS requirements and regulations related to Medicare and Medicare Advantage.
- Ability to effectively present highly complex information and respond to questions from groups of managers, clients, customers, and the public
- Technical presentation skills
- Skill in identifying and resolving problems
- Proficient at verbal and written communication
- Ability to work independently to meet company goals and timelines
- Ability to deal with change and ambiguity
- Detail oriented and accurate
- Intermediate-level computer proficiency including Google Docs and Google Sheets/Microsoft Excel
- Demonstrated compatibility with Bluestone’s mission and operating philosophies
- Demonstrated ability to read, write, speak, and understand the English language
- Must have received or be willing to receive Covid 19 vaccine by date of hire. Accommodations for disability- and religious-based reasons will be considered.
- Health Insurance
- Dental Insurance
- Vision Materials Insurance
- Company paid Life Insurance
- Company paid Short and Long-term Disability
- Health Savings Account (HSA)
- Flexible Spending Account (FSA)
- Retirement plan with 4% matching contributions
- Nine paid (non-working) holidays
- Three weeks (15 Days) Paid Time Off (PTO)
- Mileage reimbursement program for field employees
- Company sponsored cell phone & laptop