Medicare Compliance Coordinator

ZipRecruiter; Charleston (SC); Remote; USD 50,000 - 80,000; Full time

Job summary

Join a forward-thinking company dedicated to ensuring compliance with Medicare regulations as a Medicare Compliance Coordinator. In this fully remote role, you'll lead efforts to operationalize compliance requirements, monitor changes in Medicare laws, and collaborate with various internal departments. Your expertise will be essential in conducting audits, training staff, and ensuring timely reporting to regulatory agencies. This position offers a dynamic working environment with a comprehensive benefits package, including medical, dental, and 401k enrollment from day one. If you have a passion for compliance and a desire to make a difference, this opportunity is for you.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

401k Enrollment on Day 1

Flexible Working Hours

Great Working Environment

Qualifications

• 2-3+ years of Medicare Compliance experience required.
• Experience with RREs, Section 111 Reporting, and CMS regulations required.
• High School Diploma or equivalent required; 2-year degree or higher preferred.

Responsibilities

• Lead efforts to operationalize Medicare compliance requirements.
• Serve as the Medicare subject matter expert within NARS Compliance department.
• Perform compliance reviews and audits to identify opportunities.

Skills

Medicare Compliance

Regulatory Tracking

Time Management

Communication Skills

Problem-Solving

Education

High School Diploma

2-Year Degree

CHC Certification

Tools

MS Office

Job description

Job Description

NARS (North American Risk Services) is looking for a Medicare Compliance Coordinator to join our Compliance team.

Please Note - this is NOT an IT position

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

As a Medicare Compliance Coordinator, you will be responsible for ensuring the organization’s claims processing and administrative services comply with Medicare regulations. This role involves monitoring compliance programs, conducting audits, and collaborating with various internal departments to maintain adherence to federal guidelines. This position will have accountability for timely and accurate filing and reporting to state and federal regulatory agencies while supporting the claims department and clients in providing regulatory information and reports for their filings. You will also determine reporting requirements of state, federal, and international agencies, attend conferences, mentor analysts, and assist management as needed. Collaboration with our Claims, Account Management, Training, and IT teams is essential.

Essential Functions, Duties, and Responsibilities:

• Lead efforts to operationalize Medicare compliance requirements and implement controls, policies, and procedures to ensure compliance.
• Serve as the Medicare subject matter expert within NARS Compliance department, assisting internal departments with interpretation and execution of CMS rules and regulations.
• Track and monitor changes in Medicare laws, regulations, and CMS guidance; manage regulatory tracking and assess business impact, updating procedures and policies accordingly.
• Ensure timely, accurate, and efficient reporting, including error correction and analysis, in compliance with laws, agencies, and client requirements.
• Monitor and ensure NARS’ Claims System and personnel are aware of new Medicare requirements.
• Perform compliance reviews and audits to identify opportunities and monitor adherence.
• Coordinate with IT and Processing teams to update claims systems for compliance and efficiency.
• Assist with onboarding and offboarding clients, ensuring Medicare compliance during transitions.
• Ensure Medicare reporting requirements are integrated into client onboarding/offboarding processes to minimize risks.
• Support responses to client audits requiring Medicare expertise.
• Develop and support corrective action plans from audits or client recommendations, ensuring follow-through.
• Communicate with Claims, Quality Assurance, Account Management, and Operations departments on client issues and regulatory developments.
• Provide training on compliance matters as needed.
• Engage with regulatory officials regarding potential actions and fines.
• Conduct periodic ISO and Accurint searches as needed.

Work Environment Requirements:

• Extended periods of computer screen usage for data entry, research, and virtual meetings.
• Maintain focus and productivity during long hours working at a computer.

Education/Experience Requirements:

• 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 environment or at an insurance carrier is required.

Technical Skills:

• Excellent time management, scheduling, and organizational skills.
• Strong written and verbal communication skills in English.
• High level of tact and interpersonal skills for handling sensitive information.
• Ability to work independently at an advanced level.
• Proficiency in MS Office applications (Word, Excel, PowerPoint, database software).

Knowledge/Abilities:

• Reading comprehension and basic math skills.
• Ability to understand claim files, policies, and endorsements.
• Adaptability to shifting deadlines and priorities.
• Clear and concise communication with clients and stakeholders.
• Strong problem-solving, decision-making, and time management skills.
• Ability to sit for long periods and work indoors in controlled environments.
• Frequent use of keyboard, mouse, and computer screens.

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