Medicare Compliance Coordinator

ZipRecruiter; Orlando (FL); Remote; USD 40,000 - 80,000; Full time

Job summary

An established industry player is seeking a Medicare Compliance Coordinator to join their Compliance team. This role offers the flexibility of 100% remote work, allowing you to ensure adherence to Medicare regulations while enjoying a comprehensive benefits package from day one. As a key player in the organization, you will lead compliance efforts, conduct audits, and collaborate with various teams to maintain regulatory standards. If you are passionate about compliance and looking for a supportive working environment, this opportunity is perfect for you.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

401k Enrollment

Flexible Work Environment

Qualifications

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

Responsibilities

• Ensure compliance with Medicare regulations and conduct audits.
• Collaborate with internal departments for regulatory adherence.

Skills

Medicare Compliance

Regulatory Tracking

Auditing

Communication Skills

Time Management

Education

High School Diploma

2-Year Degree

Tools

Microsoft 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. You will be accountable for timely and accurate filing and reporting to state and federal regulatory agencies, supporting the claims department and clients with regulatory information and reports for their filings. You will determine reporting requirements for state, federal, and international agencies. The role requires attending conferences, client meetings, mentoring analysts, and assisting management as needed. You will work closely with our Claims, Account Management, Training, and IT teams to perform various tasks.

Essential Functions, Duties, and Responsibilities:

• Lead NARS’ efforts to operationalize Medicare compliance requirements by implementing 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, perform business impact assessments, and update procedures to maintain compliance.
• Ensure timely, accurate, and efficient reporting, including error correction and analysis, in compliance with laws, agencies, and clients regarding CMS/Medicare filings.
• Monitor and ensure NARS’ Claims System and personnel are aware of new Medicare requirements.
• Perform periodic compliance reviews and audits to identify opportunities and monitor adherence.
• Collaborate with IT and Processing teams to update claims systems for better compliance and efficiency.
• Assist with onboarding and offboarding clients from the TPA, ensuring Medicare compliance during transitions.
• Address Medicare reporting during client onboarding/offboarding to minimize gaps and risks.
• Respond to client audits requiring Medicare expertise.
• Develop or support corrective action plans from audits or client recommendations, ensuring follow-through.
• Communicate with Claims, Quality Assurance, Account Management, and Operations teams on client issues and regulatory developments.
• Provide training on compliance matters as needed or requested.
• Work 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 are required.
• 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 is necessary.
• Experience working in a Third Party Administrator claims management environment or with insurance carriers 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 confidentially.
• Ability to work independently at an advanced level.
• Proficiency in Microsoft Office applications (Word, Excel, PowerPoint, databases).

Knowledge/Abilities:

• Strong 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 customers, claimants, and involved parties.
• Strong problem-solving, decision-making, reporting, and time management skills.
• Ability to sit for long periods and work indoors in a controlled environment.
• Repeated use of keyboard, mouse, and exposure to screens.