Medicare Compliance Coordinator

ZipRecruiter; Dallas (TX); Remote; USD 50,000 - 80,000; Full time

Job summary

An established industry player is seeking a Medicare Compliance Coordinator to join their Compliance team. This remote role involves ensuring claims processing adheres to Medicare regulations, conducting audits, and collaborating with various departments. You will be responsible for timely reporting to regulatory agencies and supporting clients with compliance information. Ideal candidates will have a strong background in Medicare Compliance, excellent communication skills, and the ability to manage sensitive information. Join a dynamic team that values compliance and offers a comprehensive benefits package from day one.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

401k Enrollment on Day 1

Flexible Working Hours

Remote Work

Great Working Environment

Qualifications

• 2-3+ years of Medicare Compliance experience required.
• Experience with CMS regulations and RREs necessary.
• Ability to handle sensitive information confidentially.

Responsibilities

• Ensure compliance with Medicare regulations and guidelines.
• Lead compliance audits and monitor changes in laws.
• Provide training on compliance matters as needed.

Skills

Medicare Compliance

Regulatory Knowledge

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 internal departments to maintain adherence to federal guidelines. You will be accountable for timely and accurate filings and reporting to regulatory agencies, supporting the claims department and clients with regulatory information and reports, and determining reporting requirements for various agencies. You will attend conferences, mentor analysts, and assist management as needed, working closely with Claims, Account Management, Training, and IT teams.

Essential Functions, Duties, and Responsibilities:

• Lead efforts to operationalize Medicare compliance requirements, implementing controls, policies, and procedures.
• Serve as the Medicare SME within NARS Compliance, assisting with CMS rule interpretation and execution.
• Monitor changes in Medicare laws and regulations, manage tracking, assess impacts, and update procedures accordingly.
• Ensure accurate and timely reporting, including error correction and compliance with legal and client requirements.
• Monitor and communicate new Medicare requirements to relevant teams.
• Perform compliance reviews and audits to identify opportunities and monitor adherence.
• Collaborate with IT and Processing teams to update claims systems for compliance.
• Support onboarding and offboarding of clients, ensuring Medicare compliance during transitions.
• Address gaps in Medicare reporting during client onboarding/offboarding to minimize risks.
• Assist with client audits requiring Medicare expertise.
• Develop and support corrective action plans based on audits or client recommendations.
• Communicate with various departments on client issues, legal, and regulatory developments.
• Provide training on compliance matters as needed.
• Engage with regulatory officials regarding potential actions and fines.
• Conduct periodic searches as required.

Work Environment Requirements:

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

Education/Experience Requirements:

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

Technical Skills:

• Excellent time management, scheduling, and organizational skills.
• Strong written and verbal communication skills in English.
• Discretion and ability to handle sensitive information confidentially.
• Ability to work independently at an advanced level.
• Proficiency in MS Office applications (Word, Excel, etc.).

Knowledge/Abilities:

• Reading comprehension and basic math skills.
• Ability to understand claim files, policies, and endorsements.
• Adaptability to shifting deadlines and priorities.
• Clear communication with customers, claimants, and other parties.
• Strong problem-solving, decision-making, and time management skills.
• Ability to sit for long periods and work indoors in a controlled environment.
• Repetitive use of keyboard and mouse, exposure to screens.

Company Description

North American Risk Services (NARS) is a premier third-party claims administrator founded in 1996, handling claims for insurers, brokerages, MGAs, reinsurers, liquidation bureaus, self-insured funds, and entities. We are dedicated to producing the best results for our clients.