What are the responsibilities and job description for the Medicare Advantage Compliance Specialist - Position is located in North Canton, OH - Onsite position at Altercare Integrated Health Services?
Medicare Advantage Compliance Specialist
Valor Health Plan
North Canton, OH
Position Title: Medicare Advantage Compliance Specialist
Responsible To: Compliance Officer
Position Status: Non-Exempt/Hourly
Remote Option: Potential to work remote 1 day per week
Company Summary:
Valor Health Plan (HMO-SNP) is a Medicare Advantage Prescription Drug health plan designed specifically for Medicare beneficiaries that reside in a long-term care facility. Valor Health Plan is headquartered in North Canton and available in select Ohio CMS-approved counties.
Position Summary:
Knowledge of Medicare Advantage Part C and Part D requirements, annual reporting and data validation. Understanding of CMS (Centers for Medicare and Medicaid Services) regulatory guidance and how it affects health insurance at the operation level. Perform internal data validation with ability to evaluate and identify data trends.
Primary Duties and Responsibilities:
Collect, evaluate and document trends and metrics through effective and timely data reviews and reporting for Medicare Advantage Part C and Part D business operations.
Monthly/quarterly review of Medicare Advantage claims, appeals and grievances, enrollment and eligibility, call center data, encounter data, marketing and sales, and Part D operations. Ability to clearly write-up and communicate results.
Maintain knowledge of regulatory guideline changes and impact to health insurance operations and reporting processes.
Other duties as assigned.
Education and Qualifications:
- Bachelor’s degree in Business Administration, Finance, Accounting, Healthcare or experience in related field.
- Two years involvement in Medicare Advantage data collection preferred.
- Strong planning, and organization skills.
- Demonstrated excellent verbal and written communications skills.
- Proficiency with Microsoft Office suite, including:
- Ability to use Word to edit text documents, understanding of track changes function, etc.
- Proficient with Excel utilizing formulas, functions, and chart creation; knowledge of basic computations; knowledge of setting up .csv and .txt files; etc.
- Daily use of Outlook – send and receive emails, schedule meeting invites, and include attachments, etc.
- Frequent use of Zoom – ability to set up meetings, join meetings, and utilize share function, etc.
- Ability to learn and become proficient with CMS HPMS and Acumen portals, etc.
Physical Demands:
Ability to work extended periods sitting/standing at a desk and working on a computer.
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