Compliance Consultant - Medicare
BTG, in partnership with a top ranked healthcare company in Florida, has an immediate need for a Compliance Consultant - Medicare.
Requirements of the Compliance Consultant - Medicare
- 6-9 years of related work experience or equivalent combination of transferable experience and education
- Related Bachelor's degree (Accounting, Business Administration, or healthcare related area) or additional related equivalent work experience
- Compliance or regulatory experience (e.g. training, auditing, monitoring, investigations, issue resolution, risk management, and development and monitoring of corrective actions)
- Professional certification as a Certified Internal Auditor, Certified Fraud Examiner, Certified Public or Management Accountant, Certified Compliance and Ethics Professional, or Certified Information Privacy Professional
- In depth knowledge of applicable state and federal regulations and experience with the design and implementation of program safeguards to ensure organizational compliance
- Comprehensive knowledge of Medicare healthcare insurance products and the associated sales, service, claims, and enrollment and billing processes
- Experience working with leaders at all levels in the organization
- Demonstrated organization, facilitation, communication and presentation skills
- Proficient in Word, Excel and PowerPoint
- Project Management, Six Sigma, Lean
- Master's degree
- Advanced analytical skills demonstrating trends or cause and effect relationships (root cause analysis)
- Strong MS Excel skills such as using pivot tables, vlookup, and data analysis techniques
- Written and verbal communication experience for audiences from employees to directors
- Intermediate experience with MS Word and PowerPoint
- Advanced Excel skills
- Experience working with regulatory agencies
- Experience working with health insurance processing systems (RBMS, Siebel, Diamond, Jiva, etc.)
- Prior knowledge of CMS and/or NCQA requirements for Medicare
Benefits of the Compliance Consultant - Medicare
- Flexible hours, M-F
- REMOTE, must work EST hours
- Medical/ Dental/ Vision
Responsibilities of the Compliance Consultant - Medicare
- Demonstrate an in-depth knowledge of the Medicare health product line legal and regulatory requirements (i.e. Medicare Advantage, Medicare Supplement, Medicare Part D)
- Analyze state and federal laws, regulations, and sub-regulatory guidance to identify key compliance requirements and impacts to partner with Medicare operations teams to develop understand of impacts and required process/system changes.
- Strategize with Medicare leadership on the development of business positions and approaches to meet compliance requirements which are cost-effective and efficient, to the extent possible and obtain commitment and consensus from others across Medicare through effective communication and negotiation.
- Identify risks, gaps, and opportunities to help improve compliance oversight. Track, measure, and report on these items to leadership until resolution. Work with the business units to employ corrective measures and long-term reporting to ensure long-term success.
- Oversee and support the implementation of state and federal laws, regulations, and sub-regulatory guidance, providing subject matter expertise, identifying and understanding the risks associated with the requirements and the business impact to implementing; understand controls and the implementation of controls to help ensure compliance and mitigate risk; coordinate onsite audits or desk reviews requested by regulatory agencies.
- Develop and maintain effective working relationships with internal Medicare leadership, Enterprise Compliance, Internal Audit, and other critical parties that support the Medicare organization.
- Manage the development of educational and/or reference materials outlining regulations, interpretations and business implementations; deliver formal and informal training to internal and external business partners (e.g. one-on-one, small or larger group setting).
- Create and report out on Ops Compliance status across all verticals to the Medicare leadership and Compliance Committee.
If you believe that your skills and experience are a match for this position, please submit your most current resume and a recruiter will be in contact. Resumes can be submitted via email to ************* or by applying online at https://jobs.btginc.com. You may also give us a call at 904-998-9414 to speak to a recruiter.