Medicare Compliance Coordinator

ZipRecruiter; Phoenix (AZ); Remote; USD 60,000 - 85,000; Full time

Job summary

A leading claims management company is seeking a Medicare Compliance Coordinator to join their Compliance team. This role involves ensuring adherence to Medicare regulations, conducting audits, and collaborating with internal departments to maintain compliance. The ideal candidate will have extensive experience in Medicare compliance within a claims-management environment and possess strong analytical and communication skills.

Benefits

Great benefit package (medical, dental, vision, 401k enrollment on day 1)

Great Working Environment

Qualifications

• 2-3+ years of previous Medicare Compliance experience required.
• Experience working in a Third Party Administrator in Claims Management environment.
• Familiarity with RREs, Section 111 Reporting, and CMS.

Responsibilities

• Serve as NARS’ internal subject-matter expert on Medicare Secondary Payer regulations.
• Track and monitor changes in Medicare laws and regulations.
• Ensure compliance with federal/state laws regarding filings for CMS.

Skills

Research

Analytical Skills

Communication

Time Management

Problem Solving

Education

High School Diploma or equivalent

2-year degree or higher preferred

CHC certification or ability to obtain it

Tools

Microsoft Office

Job description

Job Description

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

North American Risk Services (NARS), a third-party claims management administrator, is looking for a Medicare Compliance Coordinator to join our Compliance team.

NARS is an independent property & casualty claims-management third-party administrator—not a health benefits or retirement administrator. Companies that outsource their property, casualty, or workers'-comp claims to NARS gain a partner that supplies seasoned adjusters, proprietary claims technology, and nationwide field resources while allowing the insurer or self-insured to retain underwriting focus and brand control. NARS delivers full-lifecycle claims management for insurers, MGAs, reinsurers, and self-insured organizations.

To support continued growth, we've created a new Medicare Compliance Coordinator role on our Compliance team.

Please Note - this is NOT an IT position. We are seeking compliance expertise - not systems analysis

The ideal candidate will bring proven Medicare-compliance expertise from a claims-management TPA environment comparable to NARS.

What You’ll Do:

• Serve as NARS’ internal subject-matter expert on Medicare Secondary Payer (MSP) regulations, Section 111 reporting, and conditional-payment recovery CMS.
• Partner with claims, onboarding, training, and IT to ensure adjusters meet all Medicare reporting and reimbursement requirements.
• Track, audit, and report on Medicare compliance metrics; recommend process improvements to leadership.
• Liaise with external regulators, TPAs, and clients on Medicare compliance questions.

What You’ll Bring:

• 2+ years of Medicare regulatory compliance work inside a claims-management or TPA environment—not health-plan or provider settings.
• Proven success training adjusters or claims staff on MSP obligations.
• Strong research and analytical skills with the ability to interpret evolving CMS guidance.
• Excellent written and verbal communication; able to translate complex rules into practical workflows.

Why NARS?

• Independent TPA focused exclusively on P&C lines—no underwriting distractions, total commitment to best-in-class claims service.
• Nationwide footprint with proprietary claims technology and seasoned field resources.
• Culture of collaboration: you’ll mentor others and shape a brand-new function.

Ready to bring your Medicare expertise to a dynamic claims-management leader? Apply today and help us keep our clients—and Medicare—fully compliant.

Need more information about the position? Check out our job description below:

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 own filings. Responsible for determining reporting requirements of state, federal, and international agencies. Ability to attend conferences, client meetings, mentor other analysts, and assist management as requested. 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 and implement necessary controls, policies, and procedures to ensure compliance.
• Serve as the Medicare subject matter expert within NARS Compliance department and assist 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 work with operational areas to perform business impact assessments, identify changes to current procedures, and implement policies and policy changes needed to maintain compliance with Medicare/regulatory requirements.
• Ensure timely, accurate, and efficient reporting, including error correction and analysis, and compliance with federal/state laws, agencies, and clients regarding filings for CMS/Medicare reporting requirements.
• Monitor and ensure NARS’ Claims System and appropriate personnel are aware of the release of all new Medicare requirements.
• Perform periodic compliance reviews and audits to identify opportunities and monitor compliance.
• Work with NARS’ IT and Processing teams to ensure changes are made to NARS’ claims system for easier and more efficient information transfer to CMS.
• Assist with onboarding and offboarding clients from the TPA, ensuring seamless compliance with Medicare during transitions.
• Ensure Medicare reporting requirements are integrated into onboarding and offboarding of clients from the TPA to address all gaps and minimize risks.
• Assist in responding to client audits where Medicare expertise is needed.
• Initiate, develop, or support corrective action plans identified through audits or by client recommendations, and ensure follow-through on changes.
• Communicate with NARS Claims, Quality Assurance, Account Management, and Operations departments on client issues, needs, and legal and regulatory developments pertaining to Medicare.
• Provide training as necessary/requested on compliance matters.
• Work with regulatory officials regarding potential regulatory actions and fines.
• Conduct periodic ISO and Accurint searches as needed.

Work Environment Requirements:

• This role requires extended periods of computer screen usage for tasks such as data entry, research, and virtual meetings.
• The ability to maintain focus and productivity while working 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 previous Medicare Compliance experience required.
• Previous responsibilities regarding RREs, Section 111 Reporting, and CMS familiarity required.
• Experience working in a Third Party Administrator in Claims Management 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.
• Advanced tact and interpersonal skills to handle sensitive and confidential situations confidently.
• Ability to work independently at an advanced level.
• Proficiency in computer software applications including Microsoft Office (Word, Excel, PowerPoint).

Knowledge/Abilities:

• Reading comprehension.
• 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.
• Work indoors in environmentally controlled conditions.
• Repeated use of keyboard and mouse, and exposure to computer screens.

Company Description

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