Medicare Compliance Specialist

Job Summary

A company is looking for a Claims Medicare and Regulatory Compliance Specialist.

Key Responsibilities

• Conducts assessments of business processes and state requirements to enhance operational efficiency and compliance
• Delivers actionable reports and analysis to stakeholders, identifying trends and root causes
• Manages regulatory oversight activities, including market conduct exams and compliance with CMS reporting requirements

Required Qualifications

• Bachelor's Degree in a related field or equivalent business experience
• 5+ years of related claims experience, particularly in quality or compliance oversight
• Experience with CMS Section 111 reporting and identifying missing eligibility data
• Applicable claims, compliance, risk, and/or legal designations are desirable
• Proficient in developing workflows for compliance reporting and monitoring processes