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Medicare Compliance Specialist
2 months ago
-This position 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).
Job 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 skills and follow-up capabilities are essential. The position involves daily reconciliation of eligibility discrepancies.
Key Responsibilities:
- Conduct reconciliation of all Medicare reports generated by CMS on a daily, weekly, and monthly basis, including necessary research.
- Process time-sensitive information, including Quality Audits.
- Analyze reports to establish daily and weekly priorities.
- Utilize a comprehensive understanding of various databases.
- Provide prompt and professional responses to internal and external inquiries, including those from Medicare Beneficiaries, Federal Regulators, Executives, and Congress members.
- Ensure compliance and accuracy in various types of member correspondence.
- Resolve eligibility discrepancies through thorough analysis of information from multiple sources, including reference-guidance, Call Center notes, and databases.
- Manage inventory control responsibilities.
- Identify and communicate opportunities for performance improvement.
- 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:
- Manage Premium Billing.
- Oversee the administration of 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 database.
3. Experience in significant company initiatives with demonstrated leadership capabilities.
4. Proven ability to interpret CMS regulatory guidance.
Skills and Abilities:
1. Excellent 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. Exceptional organizational skills.
5. Working knowledge of programming, development, and technical architecture.
6. Strong conflict resolution and problem-solving abilities.
