Medicare Advantage Compliance Specialist (Remote)

Socket.dev; Nashville (TN); Remote; USD 62,000 - 136,000; Full time

Job summary

This position supports the evaluation of Government Programs regulatory requirements, CMS guidance, and government contract obligations to assess compliance risks across HCSC's Medicare Advantage business lines. Serves as a subject matter expert (SME) on Medicare Advantage compliance, providing guidance to ensure regulatory requirements are implemented accurately and timely.

Responsibilities include evaluating Medicare Advantage regulations, CMS guidance, and Risk Adjustment requirements to

Qualifications

• Bachelor’s degree and 3 years’ experience in health plans, regulatory compliance or risk management OR 6 years’ experience in health plans, regulatory compliance, or risk management.
• Ability to communicate with and build relationships with internal business units.
• Build relationships with various external government agencies as well.

Responsibilities

• Evaluate Medicare Advantage regulations, CMS guidance and Risk Adjustment requirements to identify compliance risks.
• Conduct monitoring and oversight activities including universe and report reviews and high-risk area reviews.
• Collaborate with compliance, operational and cross-functional teams to promote risk management and regulatory compliance.

Skills

Regulatory compliance

Risk assessment

Verbal and written communication

Relationship building

PC proficiency

Education

Bachelor's degree

3+ years in health plans/regulatory

Tools

Word

PowerPoint

Excel

Job description

This position supports the evaluation of Government Programs regulatory requirements, CMS guidance, and government contract obligations to assess compliance risks across HCSC's Medicare Advantage business lines. Serves as a subject matter expert (SME) on Medicare Advantage compliance, providing guidance to ensure regulatory requirements are implemented accurately and timely.

Responsibilities include evaluating Medicare Advantage regulations, CMS guidance, and Risk Adjustment requirements to