Medicare Compliance Analyst

Description

Job Description:

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 of 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 assessment(s), 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 to be sent to CMS.
• Assists with on-boarding and off-boarding clients from the TPA and ensuring seamless compliance with Medicare during any transitions.
• Ensures Medicare reporting requirements are integrated into on-boarding and off-boarding of clients from the TPA to ensure all gaps are addressed and risks are minimized.
• Assist in responding to client audits where Medicare expertise is needed.
• Initiate, develop, or support corrective action plans identified through audits or by recommendation of clients and ensure follow-through on identified changes.
  
  

Communicate with NARS Claims, Quality Assurance, Account Management and Operations departments on various 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, as needed, periodic ISO and Accurint searches.
  
  

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 for 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 preferred or the ability to obtain.
• 2-3 years previous Medicare Compliance required.
• Previous responsibilities regarding RREs, Section 111 Reporting and CMS familiarity required.
• Working in a TPA environment or at a required carrier.
  
  

Technical Skills:

• Excellent time management, scheduling, and organizational skills.
• Strong communication skills, both written and verbal in English.
• Advanced level of tact and interpersonal skills to confidentially handle sensitive and confidential situations and information.
• Must have an advanced level of being able to work independently.
• Advanced knowledge of a variety of computer software applications in word processing, spreadsheets, database, and presentation software. (Microsoft Office platform.)
• Must have strong computer skills (MS Office, Excel, Word, etc.)
  
  

Knowledge/Abilities:

• Reading Comprehension.
• Basic math knowledge.
• Able to understand claim files, commercial policies, and endorsements.
• Ability to adapt to shifting deadlines and priorities
• Must be able to communicate clearly and concisely with customers, claimants, and other involved parties.
• Must have strong problem solving, decision-making, reporting, communication and
  
  

time management skills.

• Requires long periods of sitting.
• Requires working indoors in environmentally controlled conditions.
• Repeated use of a keyboard, mouse, and exposure to computer screens.