Medicare Insurance Compliance Manager

Description

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

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