What are the responsibilities and job description for the Claims Medicare and Regulatory Compliance Specialist position at AmTrust Financial?
Claims Medicare and Regulatory Compliance Specialist
Job Locations US-United States
Requisition ID
JR1003279
Category
Compliance
Position Type
Regular Full-Time
Overview
Responsible for leading the development and implementation of quality / compliance / legal assessments and / or manages compliance activities to ensure effective oversight of operational risk. Briefs senior leadership on results, trends, studies, and initiatives. Recommends process improvements and escalates existing and emerging risks associated to business processes. Acts as a trusted advisor for the business and mentors' peers. Maintains a solid understanding of AmTrust's mission, vision, and values. Upholds the standards of the AmTrust organization.
Qualifications
Ensure Compliance with CMS Section 111 Reporting Requirements : Oversee accurate and timely Section 111 reporting for Medicare, including capturing and submitting data related to claimants' Medicare eligibility, total payment obligations to claimants (TPOCs), and ongoing responsibility for medicals (ORM).
- Identify and Address Missing Eligibility Data : Collaborate with claims teams to identify gaps in claimant eligibility data and implement processes to ensure accurate reporting to the Centers for Medicare & Medicaid Services (CMS), minimizing potential penalties and compliance risks.
- Monitor and Improve Reporting Processes : Develop and maintain robust workflows for CMS reporting, including validation of data submissions, resolution of errors, and ensuring compliance with updates to CMS Section 111 guidelines and thresholds.
- Bachelor's Degree in related field OR equivalent business experience.
- 5 years of related claims experience, with recent background in a quality or compliance oversight role.
- Strong oral and written communication skills with demonstrated ability to translate information in a way that is easily understood by varying audiences. Ability to influence others to facilitate change.
- Demonstrated proficiency in prioritization of work based on business requirements and capacity planning.
- Strong understanding of the procurement / sourcing process.
- Applicable compliance, risk, and / or legal designations such as ARM, CRCMP, CLMP, ARC, etc.
Preferred :
This job description is designed to provide a general overview of the requirements of the job and does not entail a comprehensive listing of all activities, duties, or responsibilities that will be required in this position. AmTrust has the right to revise this job description at any time.
AmTrust
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What We Offer
AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include : Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.
AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.
AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.
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