Medicare Compliance Specialist
1 week ago
-This role is Remote, with initial training potentially conducted in-office and participation in the annual AEP Meeting.
Applicants should possess experience in Medicare/Medicare Advantage and the Annual Enrollment Period (AEP).
Position Overview:
This role entails a comprehensive understanding of and adherence to Federal Centers for Medicare and Medicaid Services regulations. The environment is dynamic, requiring adaptability to frequent changes in priorities. Strong organizational and follow-up skills are essential for success. The position involves daily policy reconciliation and addressing systemic eligibility discrepancies.
Key Responsibilities:
- Reconcile all Medicare reports generated daily, weekly, and monthly from CMS, conducting research as necessary.
- Process time-sensitive information, including Quality Audits.
- Analyze reports to establish daily and weekly priorities.
- Utilize a thorough understanding of multiple databases.
- Provide prompt and professional responses to internal and external stakeholders, including Medicare Beneficiaries, Federal Regulators, Executives, and Congressional representatives.
- Ensure compliance and accuracy in various types of member correspondence.
- Resolve eligibility discrepancies by analyzing information from multiple sources, including reference guidance, Call Center notes, and databases.
- Manage inventory control responsibilities.
- Identify and communicate opportunities for improving processing performance.
- Perform additional duties as assigned by management.
Demonstrate knowledge of the laws, regulations, and policies relevant to the organizational unit's operations, ensuring compliance in all job responsibilities.
Additional Responsibilities:
- Oversee Premium Billing processes.
- Administer the delinquency outreach program for members with outstanding premium payments.
- Review and reconcile member premium bills and financial accounts.
Qualifications:
1. High School diploma or GED required; Bachelor's degree from an accredited institution preferred.
2. Minimum of three (3) years of experience in Health Insurance or related Medicare fields.
Knowledge Requirements:
1. In-depth knowledge of system development life cycle and implementation methodologies.
2. Proficiency in structured query languages, analytical techniques, and Access databases.
3. Experience in leading significant company initiatives and demonstrating leadership capabilities.
4. Proven ability to interpret CMS regulatory guidance.
Skills and Abilities:
1. Exceptional written and verbal communication skills.
2. Ability to convey information clearly and concisely.
3. Strong PC skills, including proficiency in spreadsheets and word processing.
4. Excellent organizational skills.
5. Familiarity with programming, development, and technical architecture.
6. Conflict resolution and problem-solving capabilities.
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