Medicare Compliance Analyst
Raleigh, NC, USA
- Richmond, VA, USA
- Scottsdale, AZ, USA
- Virtual Req #203
Tuesday, December 31, 2024
Come grow with James River Insurance!
James River Insurance is an excess and surplus lines segment of James River Group Holdings, Ltd. and operates on an approved non-admitted basis in 50 states and Washington, DC. Since 2003, James River has provided thousands of commercial property and casualty customers with innovative and creative solutions for particular insurance needs.
At James River Insurance, we are committed to providing a stable and rewarding work environment supported by our Core Values and Guiding Principles : Integrity, Accountability, Innovation, Customer Service, Communication, and Teamwork. We are proud of our recent national recognition as a 2023, 2022, and 2021 Top Workplaces USA awards.
James River Group Holdings, Ltd. is a Bermuda-based insurance holding company which owns and operates a group of specialty insurance and reinsurance companies. The Company operates in two specialty property and casualty insurance segments : Excess and Surplus Lines and Specialty Admitted Insurance. The Company tends to focus on accounts associated with small or medium-sized businesses in each of its segments. Each of the Company's regulated insurance subsidiaries are rated "A-" (Excellent) by A.M. Best Company.
Job Summary
The Medicare Secondary Payer (MSP) Compliance Analyst supports the claims team by ensuring compliance with Section 111 of the MMSEA and other federal and state regulations. This role involves monitoring, analyzing, and interpreting MSP compliance requirements, implementing corrective actions, and ensuring alignment with regulatory standards.
Duties and Responsibilities
Continuously exhibit and uphold Core Values of Integrity, Accountability, Communication and Teamwork, Innovation and Customer ServiceStay abreast of CMS and other relevant regulatory bodies' guidelines, laws, and regulations to ensure compliance in all Medicare-related operationsServe as the primary liaison to MSP related vendors, ensuring effective communication and collaborationAnalyze and revise company policies and procedures to ensure alignment with Medicare regulations and assist in drafting new policies as neededPerform regular risk assessments related to Medicare compliance, identifying areas for improvement and recommending corrective actions to minimize risksParticipate in internal audits by reviewing the Claim System and external MSP Navigator data, and addressing audit findings and implementing corrective actionsDevelop and deliver training sessions for internal teams on MSP compliance topics, regulatory changes, and policy updatesPrepare and submit accurate, timely reports to management and regulatory agencies, maintaining records of all compliance activitiesMonitor and analyze data to identify trends and potential compliance gaps, using insights to develop strategies to enhance complianceWork closely with departments such as Corporate Legal and Compliance to ensure adherence to all MSP-related compliance requirementsAssist in investigating MSP compliance issues and collaborate with teams to develop and execute corrective action plansManage and resolve complaints or issues related to MSP compliance, ensuring timely and effective solutionsKeep detailed records of all compliance activities, including risk assessments, audits, training, and corrective actionsEnsure adherence to state Medicaid requirements and monitor compliance with relevant regulationsEnsure child support liens are managed in accordance with state regulationKnowledge, Skills and Abilities
Advanced knowledge of Medicare and MSP requirements, specifically related to 111 MMSEA (Medicare Reporting) standardsAdvanced knowledge of health insurance policies and proceduresAdvanced knowledge of CMS guidelines, Medicare Advantage, and Part D regulations, as well as state and federal healthcare lawsIntermediate knowledge in the use of Verisk products, including MSP NavigatorIntermediate knowledge of MSP Navigator and Guidewire productsAdvanced proficiency in regulatory reporting tools and systemsAdvanced proficiency in Microsoft Office Suite (Word, Excel, PowerPoint)Expertise in negotiating and resolving Medicare conditional payments (liens)Proficiency in managing liability and no-fault claimsSkilled in establishing Medical Set AsidesAbility to make critical and complex decisions using sound judgmentStrategic thinker with creative problem-solving abilitiesExcellent written and verbal communication skillsExperience and Education
High School degree requiredBachelor's degree in related field (Healthcare Administration, Business) preferredMinimum of seven years of experience in Medicare compliance, regulatory and state filings, or a related field within the healthcare or insurance industry requiredMSP Accreditation preferredExperience with Medicare-related audits and compliance programs preferredLI-KS1
LI-Remote
Other details
Job Family ComplianceJob Sub Family CompliancePay Type SalaryApply Now
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