Medicare Compliance Coordinator

ZipRecruiter; Atlanta (GA); Remote; USD 60,000 - 75,000; Full time

Job summary

Join a leading claims management company as a Medicare Compliance Coordinator. This role involves ensuring compliance with Medicare regulations, conducting audits, and collaborating with various departments. Enjoy a fully remote position with a comprehensive benefits package.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

401k Enrollment on Day 1

Qualifications

• 2-3+ years of Medicare Compliance experience required.
• CHC certification or ability to obtain it.

Responsibilities

• Ensure compliance with Medicare regulations in claims processing.
• Conduct audits and monitor compliance programs.
• Provide regulatory information and reports.

Skills

Time Management

Communication

Problem Solving

Education

High School Diploma

2-year Degree

Tools

Microsoft Office

Job description

Job Description

NARS (North American Risk Services) is a top Third Party Administrator in Claims Management. NARS is looking for a Medicare Compliance Coordinator to join our Compliance team.

Please Note - this is NOT an IT position

The ideal candidate will have previous Medicare Compliance experience working in a Claim's Management Carrier / Third Party Administrator environment.

• 100% Working-From-Home!
• Great benefit package (medical, dental, vision, 401k enrollment on day 1 and much more!)
• Great Working Environment

Responsibilities

As a Medicare Compliance Coordinator, you will be responsible for ensuring the organization’s claims processing and administrative services comply with Medicare regulations. Your duties include monitoring compliance programs, conducting audits, collaborating with internal departments to maintain adherence to federal guidelines, and ensuring timely and accurate filings and reports to regulatory agencies. You will support the claims department and clients by providing regulatory information and reports, determining reporting requirements, and attending conferences and meetings. You will also mentor analysts and assist management as needed, working closely with Claims, Account Management, Training, and IT teams.

Essential Functions

• Lead efforts to operationalize Medicare compliance requirements, implementing controls, policies, and procedures.
• Serve as the Medicare subject matter expert within NARS Compliance department, assisting with interpretation and execution of CMS rules.
• Track changes in Medicare laws and regulations, assess business impact, and update procedures to ensure compliance.
• Ensure accurate and timely reporting to CMS and other agencies, including error correction and analysis.
• Monitor Medicare requirements and communicate updates to relevant teams.
• Conduct compliance reviews and audits to identify opportunities for improvement.
• Collaborate with IT and Processing teams to update claims systems for compliance.
• Assist with client onboarding and off-boarding, ensuring Medicare compliance during transitions.
• Support responses to client audits and develop corrective action plans.
• Communicate with internal departments on compliance issues and regulatory developments.
• Provide training on compliance matters as needed.
• Engage with regulatory officials regarding potential actions and fines.
• Conduct periodic searches such as ISO and Accurint as needed.

Work Environment

• This role requires extended periods of computer use for data entry, research, and virtual meetings.
• Ability to maintain focus and productivity during long hours in front of a screen is essential.

Education and Experience

• High School Diploma or equivalent required; 2-year degree or higher preferred.
• CHC certification or ability to obtain it.
• 2-3+ years of Medicare Compliance experience required.
• Experience with RREs, Section 111 Reporting, and CMS regulations required.
• Experience working in a Third Party Administrator or insurance carrier environment is necessary.

Technical Skills

• Excellent time management, scheduling, and organizational skills.
• Strong written and verbal communication skills in English.
• Ability to handle sensitive information confidentially.
• Ability to work independently at an advanced level.
• Proficiency in Microsoft Office applications.

Knowledge and Abilities

• Reading comprehension and basic math skills.
• Understanding of claim files, policies, and endorsements.
• Adaptability to shifting deadlines and priorities.
• Clear and concise communication skills.
• Strong problem-solving, decision-making, and time management skills.
• Ability to work indoors in environmentally controlled conditions.
• Repeated use of keyboard, mouse, and exposure to screens.

Company Overview

North American Risk Services (NARS) is a premier third-party claims administrator dedicated to delivering optimal results for clients. Founded in 1996, we handle claims for insurers, brokerages, MGAs, reinsurers, liquidation bureaus, self-insured funds, and other entities.