Medicare Insurance Compliance Manager

4 weeks ago

Brentwood, United States My Senior Health Plan Full time
Job DescriptionJob DescriptionDescription:

MySeniorHealthPlan.com is a direct-to-consumer insurance brokerage specializing in Medicare. We pride ourselves on our ability to provide honest & non-biased comparisons given we represent most top insurance carriers. While other companies might represent many lines of insurance, our expertise is Senior Health Insurance. By focusing primarily on Senior Health Insurance, we are always up to date on the latest Senior Health Insurance products, technologies, and news.


We are rapidly expanding and are looking for an experienced Medicare Insurance Compliance Manager to join our team This position is based in our new Brentwood (Nashville), TN office. The position would be full time onsite to start, but hybrid could be negotiated after training based on performance.


The ideal candidate is someone possessing a comprehensive understanding of healthcare regulations and related laws, combined with the ability to effectively analyze and interpret data. They should be an effective communicator who can work collaboratively to ensure compliance with applicable laws and regulations.


To be successful in this role, you must have a minimum of 3-5 years of experience in insurance compliance, with a particular focus on Medicare and Medicaid regulations. You should have a deep understanding of the healthcare industry and a working knowledge of provider credentialing processes. Additionally, you must have the ability to manage multiple projects simultaneously and possess strong problem-solving and analytical skills. Above all, you must be a highly organized individual with excellent interpersonal and communication skills.


If this sounds like you, please apply now


Summary:


Under the direction of the President/CEO and the Business Operations Officer, the Medicare Insurance Compliance Manager's purpose is to provide oversight with all CMS and state regulatory requirements, contract requirements, company policy and procedures, and for developing, conducting, coordinating and reporting audit and investigative activities for the purpose of preventing and detecting fraud, abuse, and waste.


The Compliance Manager will assist in developing and monitoring compliance with all CMS, Medicare advantage, Part D and DSNP regulatory requirements; will serve as a subject-matter expert on compliance topics, and by maintaining comprehensive knowledge of applicable laws, regulations and policies; will track and regularly report on Compliance Program metrics.


ESSENTIAL DUTIES AND RESPONSIBILITIES:


· Will be responsible for developing and monitoring compliance with all CMS, advantage, Part D and DSNP regulatory requirements in accordance with state and federal statutory and regulatory requirements and MSHP policies and procedures


· Oversee Leads compliance strategy, programs and goals


· Stays current on industry developments and changes in health insurance regulations


· Possess knowledge and understanding of the requirements for effective compliance programs as set forth in OIG Guidance and the Federal Sentencing Guidelines


· Possess knowledge of HIPAA policy and procedures, federal and state regulatory processes


· Works with leaders to ensure internal controls are sufficient to maintain compliance


· Participates in the development of risk assessment tools and develops a comprehensive audit plan tailored to address the relative risks presented by each business unit


· Identify, review and monitor compliance issues and opportunities for enhancing organizational compliance


· Coordinate responses to identified compliance questions, concerns or federal/state inquiries or investigations


· Draft, update, and implement Compliance Program policies


· Provide guidance and training to staff on CMS and Carrier regulations


· Manage/oversee projects, initiatives, regulatory audits, internal audits, risk assessments, audit planning, conducting mock audits, managing audit evidence preparation, and assessing audit preparedness


· Assist with the coordination and submission of SMAC, CMS filings, regulatory forms, surveys, reports and documents as required or requested by management


· Assist in miscellaneous duties and ad hoc projects


· Other projects and duties as assigned


SUPERVISORY RESPONSIBILITIES:


None


REPORTS TO:


Business Operations Manager; President/CEO


We offer:

  • Competitive base pay, based on experience, and bonuses
  • Health insurance including Medical, Dental, Life, and Vision – Employer pays 70%
  • 401k Match and Profit-sharing
  • Paid Sick Time & Vacation Time
  • Paid Holidays
  • A Positive work environment
  • Corporate Wellness Program with a discounted gym membership

APPLY TODAY

My Senior Health Plan is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, religious creed, gender, sexual orientation, gender identity, gender expression, transgender, pregnancy, marital status, national origin, ancestry, citizenship status, age, disability, protected Veteran Status, genetics or any other characteristic protected by applicable federal, state, or local law.


*All offers of employment are contingent upon successfully passing a pre-employment drug test and background check.

My Senior Health Plan* participates in E-Verify.*



Benefit Conditions:

  • Waiting period may apply
  • Only full-time employees eligible

Job Type: Full-time


Benefits:

  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Health insurance
  • Life insurance
  • Paid time off
  • Professional development assistance
  • Referral program
  • Retirement plan
  • Vision insurance

Schedule:

  • 8 hour shift
  • Day shift
  • Monday to Friday

Supplemental pay types:

  • Bonus pay
Requirements:

Experience:

  • Insurance compliance, with a particular focus on Medicare and Medicaid regulations 3-5 years (Required)
  • Using a CRM: 3 years (Required)
  • Medicare managed care, Part D care systems: 3 years (Required)
  • healthcare industry and operations: 3 years (Required)
  • CMS and state programs: 3 years (Required)
  • Antifraud activities: 3 years (Required)
  • DSNP regulations: 3 years (Required)

Education:

  • Bachelor's degree (Required)
  • Master’s degree (Preferred)

Language:

  • English (Required)
  • Spanish (Preferred)

Work Location:

  • One location – in office

Work Remotely:

  • Hybrid/Remote possible after Training Period completion

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