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Medicare Compliance Coordinator

Are you someone who is detail oriented, enjoys research and analysis, and likes to take on new and interesting topics, and being the resource and answer hub? If so, Medical Associates Health Plans is hiring a Medicare Compliance Coordinator!

Schedule: Mon-Fri, 8:00-5:00

Benefits Package Includes:

  • Single or Family Health Insurance with discounted premium rates for wellness program participation.
  • 401k with immediate matching (50% on the dollar up to 7% of pay) + additional annual Profit Sharing
  • Flexible Paid Time Off Program (24 days off/year)
  • Medical and Dependent Care Flex Spending Accounts
  • Life insurance, Long Term Disability Coverage, Short Term Disability Coverage, Dental Insurance, etc.

Skills Needed: 

  • Effective writing and communication skills
  • Ability to dive in and research topics
  • Strong organization skills

Essential Functions & Responsibilities:

  • Keep abreast of CMS (Centers for Medicare and Medicaid) regulations and guidance, as well as HPMS (Health Plan Management) System requirements, related to Medicare Advantage and Medicare Cost Plans.  Communicate to and work with staff as necessary to track and document health plan compliance with CMS requirements.
  • Develop and implement auditing and monitoring plans and processes to identify program issues and help the business address them. Recommend opportunities and plans to improve compliance, and track implementation.
  • Ensure compliance with applicable timelines, regulatory requirements, and quality standards by conducting audits and examining records, reports, practices and documentation. This includes oversight and auditing of First Tier, Downstream and Related Entities (FDRs) performing Medicare-related functions on behalf of MAHP.
  • Facilitate and perform necessary updates and health plan submissions in HPMS and CMS systems.
  • Establish and implement policies, procedures, and best practices across MAHP, and collaborate with operational areas, to promote compliance with Medicare laws and regulations, as well as other regulatory requirements (such as HIPAA, etc).
  • Assist in development, implementation and documentation of MAHP’s Compliance Program; coordinate and perform training and oversight for compliance-related activities.
  • Complete all other assigned projects and duties.

Knowledge, Skills & Abilities:

Experience: Three years to five years of similar or related experience.

Education: Equivalent to a two‑year college degree or completion of a specialized course of study or certification at a business or trade school.

Interpersonal Skills: The ability to motivate or influence others is a material part of the job, requiring a significant level of diplomacy and trust.  Obtaining cooperation (internally and/or externally) is an important part of the job.

Other Skills: Background in research and writing preferred. Legal training, college research focus such as English or history preferred. Experience in managed care/employee benefits. Proficient in Excel and other Microsoft products.