Compliance Specialist - Medicare/Medicaid

SUMMARY

Responsible for providing expert guidance to internal and external customers by conducting technical compliance research and drafting summary responses to issues affecting complex regulatory compliance. Completes annual risk assessments of downline call centers, acquired partners, and internal SMS departments. Corresponds to carrier audits as assigned.

This is a remote role if located outside of 50 miles from the Omaha, NE office

Hybrid schedule if located within 50 miles of the Omaha office

ESSENTIAL DUTIES AND RESPONSIBILITIES

Researches complex compliance issues using agreed sources; provides concise timely technical responses citing appropriate source material.

Collaborates in monitoring and reviewing regulatory and legislative changes, as well as preparing appropriate responses to regulatory changes under the guidance of legal counsel; oversees review to

ensure appropriate changes are implemented.

Stays abreast of industry trends and recommends/implements changes to internal company processes, as needed.

Identifies issues that require legal interpretation and recommends seeking formal advice from legal counsel when necessary.

Documents all issues and responses according to established business protocol.

Provides ongoing client communication to assist with day-to-day service issues.

Assists in completing carrier audits and risk assessments.

Researches and supports new initiatives to increase efficiency, profitability, productivity, and compliance.

Complies with agency management system data standards and data integrity (enters and maintains complete and accurate information).

Performs all duties in accordance with all company policies and procedures, and all federal, state and local laws, wherein the Company operates.

Performs other duties as assigned.

QUALIFICATIONS

EDUCATION/EXPERIENCE

Bachelors Degree or an equivalent combination of education and experience

Five (5) or more years of Compliance experience in industry

Three (3) or more years of working within Federally mandated programs

SKILLS

Excellent verbal and written communication skills

Good problem solving and time management skills

Ability to work within a team and to foster teamwork

Ability to prioritize work for multiple projects and deadlines

Good planning, organization, and prioritization skills

Proficient in Microsoft Office products

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