Medicare Compliance Coordinator

ZipRecruiter; Memphis (TN); Remote; USD 55,000 - 75,000; Full time

Job summary

A leading company is seeking a Medicare Compliance Coordinator to ensure compliance with Medicare regulations in claims processing. The role involves monitoring compliance programs, conducting audits, and collaborating with various departments. This position offers a 100% work-from-home option and 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 claims processing complies with Medicare regulations.
• Lead efforts to implement Medicare compliance controls.
• Conduct compliance reviews and audits.

Skills

Time Management

Communication

Problem Solving

Education

High School Diploma

2-year degree or higher

Tools

Microsoft Office

Job description

Job Description

NARS (North American Risk Services), a third-party Claims Management administrator, is seeking 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 Claims 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

As a Medicare Compliance Coordinator, your responsibilities include ensuring claims processing and administrative services comply with Medicare regulations, 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 reports to regulatory agencies, supporting claims and client needs, and determining reporting requirements for various agencies. You may also 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 subject matter expert and assist internal departments with CMS rules and regulations.
• Track changes in Medicare laws and regulations, manage regulatory tracking, assess business impacts, and update procedures accordingly.
• Ensure timely, accurate reporting and compliance with federal/state laws and client requirements.
• Monitor updates in Medicare requirements and inform relevant personnel.
• Perform compliance reviews and audits to identify opportunities and ensure adherence.
• Coordinate with IT and Processing teams to update claims systems for compliance.
• Assist with client onboarding and offboarding, ensuring Medicare compliance during transitions.
• Respond to 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 related to Medicare.
• Provide training on compliance matters as needed.
• Engage with regulatory officials regarding potential actions and fines.
• Conduct periodic searches for compliance verification as needed.

Work Environment Requirements:

• This role requires extended 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/Experience Requirements:

• High School Diploma or equivalent required; 2-year degree or higher preferred.
• CHC certification or the 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 TPA or insurance carrier claims management environment is necessary.

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 and proactively.
• Proficiency with Microsoft Office applications (Word, Excel, PowerPoint).

Knowledge/Abilities:

• Reading comprehension.
• Basic math skills.
• Understanding of claim files, policies, and endorsements.
• Ability to adapt to shifting deadlines and priorities.
• Effective communication with customers, claimants, and stakeholders.
• Strong problem-solving, decision-making, and reporting skills.
• Ability to sit for long periods and work indoors in controlled conditions.

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