Medicare Compliance Specialist - On-Site

Astiva Health

Orange (CA)

Hybrid

USD 70,000 - 100,000

Full time

7 days ago

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Benefits offered by this job

401(k)

Dental Insurance

Health Insurance

Life Insurance

Vision Insurance

Paid Time Off

Job summary

Astiva Health, located in Orange, CA, is seeking a Compliance Specialist to develop and maintain its Compliance Program and support daily operations. This on-site role involves investigating complaints, implementing preventative compliance measures, and reporting to leadership and the Board.

You will collaborate with legal and management to ensure state and federal regulatory adherence. Requirements include a Bachelor's degree or equivalent experience, 2 years in Medicare Advantage or PDP, and

Qualifications

Bachelor's degree or equivalent experience is required.
Two years of prior experience with Medicare Advantage Organizations or PDP plans.
Knowledge of risk assessment concepts is required.
Familiarity with CMS Medicare Guidelines.
Ability to work in a team and manage multiple tasks simultaneously.
Proficiency in MS Word and Excel.

Responsibilities

Collaborate with internal stakeholders on Compliance issues.
Prepare reports and analyses under guidance of General Counsel/Compliance Officer.
Advise leadership on compliance matters with the legal department.
Develop and deliver employee training on compliance policies.
Ensure compliance with state and federal regulations across business units.
Investigate sales allegations and document findings.
Track complaints in the Medicare Compliance database and manage documentation.
Assist in internal reporting of complaints and investigation statuses.