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Medicare Compliance Coordinator

Job Overview

Description

Are you someone who is detail oriented, enjoys research and analysis, and likes to take on new and interesting topics, and being the resource and answer hub? If so, Medical Associates Health Plans is hiring a Medicare Compliance Coordinator!

Schedule: Mon-Fri, 8:00-5:00

Benefits Package Includes:

• Single or Family Health Insurance with discounted premium rates for wellness program participation.
• 401k with immediate matching (50% on the dollar up to 7% of pay) + additional annual Profit Sharing
• Flexible Paid Time Off Program (24 days off/year)
• Medical and Dependent Care Flex Spending Accounts
• Life insurance, Long Term Disability Coverage, Short Term Disability Coverage, Dental Insurance, etc.

Skills Needed: 

• Effective writing and communication skills
• Ability to dive in and research topics
• Strong organization skills

Essential Functions & Responsibilities:

• Keep abreast of CMS (Centers for Medicare and Medicaid) regulations and guidance, as well as HPMS (Health Plan Management) System requirements, related to Medicare Advantage and Medicare Cost Plans.  Communicate to and work with staff as necessary to track and document health plan compliance with CMS requirements.
• Develop and implement auditing and monitoring plans and processes to identify program issues and help the business address them. Recommend opportunities and plans to improve compliance, and track implementation.
• Ensure compliance with applicable timelines, regulatory requirements, and quality standards by conducting audits and examining records, reports, practices and documentation. This includes oversight and auditing of First Tier, Downstream and Related Entities (FDRs) performing Medicare-related functions on behalf of MAHP. 
• Facilitate and perform necessary updates and health plan submissions in HPMS and CMS systems.
• Establish and implement policies, procedures, and best practices across MAHP, and collaborate with operational areas, to promote compliance with Medicare laws and regulations, as well as other regulatory requirements (such as HIPAA, etc).
• Assist in development, implementation and documentation of MAHP’s Compliance Program; coordinate and perform training and oversight for compliance-related activities. 
• Complete all other assigned projects and duties.

Knowledge, Skills & Abilities:

Experience: Three years to five years of similar or related experience.

Education: Equivalent to a two‑year college degree or completion of a specialized course of study or certification at a business or trade school.

Interpersonal Skills: The ability to motivate or influence others is a material part of the job, requiring a significant level of diplomacy and trust.  Obtaining cooperation (internally and/or externally) is an important part of the job.

Other Skills: Background in research and writing preferred. Legal training, college research focus such as English or history preferred. Experience in managed care/employee benefits. Proficient in Excel and other Microsoft products. 

Physical Aspects:

Reaching - Extending hand(s) and arm(s) in any direction.

Lifting - Raising objects from a lower to a higher position or moving objects horizontally from position-to-position. This factor is important if it occurs to a considerable degree and requires the substantial use of the upper extremities and back muscles.

Fingering - Picking, pinching, typing or otherwise working, primarily with fingers rather than with the whole hand or arm as in handling.

Grasping - Applying pressure to an object with the fingers and palm.

Talking - Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly or quickly.

Hearing - Perceiving the nature of sound with or without correction. Ability to receive detailed information through oral communication and to make fine discriminations in sound, such as when making fine adjustments on machined parts.

Repetitive Motions - Substantial movements (motions) of the wrists, hands and/or fingers.

Sedentary Work - Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Environmental Conditions:
None - The worker is not substantially exposed to adverse environmental conditions (such as in typical office or administrative work).

Medical Associates Clinic & Health Plans is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, pregnancy, age, national origin, marital status, parental status, disability, veteran status, or other distinguishing characteristics of diversity and inclusion, or any other protected status.

Please view Equal Employment Opportunity Posters provided by OFCCP here.