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    Medicare Compliance Specialist - New York, United States - MetroPlusHealth

    MetroPlusHealth
    MetroPlusHealth New York, United States

    1 day ago

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    Description

    Join a Mission-Driven Team at MetroPlusHealth

    MetroPlusHealth is dedicated to empowering New Yorkers and uniting communities through compassionate care. With a firm belief that healthcare is a fundamental right, not a privilege, we are seeking individuals with a collaborative spirit to join our team. At MetroPlusHealth, you can make a difference and take pride in your work every day.

    About Our Organization

    As a part of the NYC Health + Hospitals network, MetroPlusHealth delivers top-tier healthcare services to residents across New York City. Our offerings range from New York State Medicaid Managed Care to Medicare and various other programs designed to meet our members' diverse needs. With over 30 years of commitment to fostering strong relationships with our members and providers, we aim to help New Yorkers lead healthier lives.

    Position Summary

    As the Medicare Regulatory Compliance Specialist reporting to the Senior Manager of Medicare Regulatory Compliance, you will play a crucial role in ensuring adherence to Medicare requirements within our organization. Your responsibilities will involve overseeing and managing the Medicare Compliance Program, implementing regulatory changes, and addressing compliance issues effectively.

    Job Responsibilities

    • Ensure effective implementation of regulatory requirements across internal and external business areas.
    • Translate regulatory guidelines into actionable Compliance initiatives.
    • Maintain and update Compliance Department trackers, tracking due dates diligently.
    • Identify and escalate potential noncompliance risks.
    • Verify the implementation of regulatory mandates by gathering relevant documentation.
    • Review operational policies and procedures to guarantee compliance with regulations.
    • Thoroughly investigate all Medicare regulatory compliance issues.
    • Support Compliance leadership in external audits and regulatory requests.
    • Assist in developing annual risk assessments and work plans related to Medicare regulatory compliance.
    • Regularly review and update Regulatory Compliance policies and procedures for the Medicare line of business.
    • Contribute data for Internal Compliance Committee Meetings and Board of Directors' Audit and Compliance Subcommittee.
    • Perform any other duties as assigned.

    Minimum Requirements

    • Bachelor's degree is a must.
    • 4 years of experience in managed care, preferably in regulatory affairs/compliance.
    • Proficiency in handling HPMS Memos, CMS Final Rules, and Medicare Managed Manuals.
    • Familiarity with Part C & D requirements and operational workflows.
    • Experience in implementing corrective action plans and resolving compliance issues.
    • CHC, CCEP certification is a plus.

    Key Competencies

    • Deep knowledge of managed care, Medicare regulations, and compliance oversight.
    • Ability to work independently and lead cross-functional initiatives.
    • Experience in managing multiple projects and teams to meet organizational objectives.
    • Outstanding communication and analytical skills for articulating corporate objectives and regulations.
    • Commitment to handling confidential materials with the utmost integrity.
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