Medicare Compliance Officer: Medicare Part C & D
About The Position
National HealthCare Corporation seeks to hire a full-time Medicare Compliance Officer to join the Compliance Team. This role is responsible for ensuring the implementation, monitoring, assessment, and adaptation of NHC’s Compliance Plan and Federal Government Sentencing Guidelines for Medicare Parts C & D lines of service. The officer will monitor federal and state documents for timely communication and implementation of new requirements, develop and revise compliance training programs, and respond to reports received via the CTM, anonymous hotline, or other channels related to Medicare Parts C & D. The position also involves assisting the Corporate Compliance Officer and Operations in responding to allegations of fraud, waste, and abuse, developing corrective actions, reviewing operational and clinical metric reports, and providing compliance oversight of First Tier, Downstream, and Related Entities (FDRs).
Requirements
- Associate’s or bachelor’s degree in healthcare field required.
- 2-3 years of experience in compliance related to Medicare Parts C & D.
- Knowledge of industry standards for Medicare Parts C & D.
- Knowledge of regulatory standards for affected area of responsibility.
- Knowledge of continuous improvement and change management.
- Excellent written and verbal communication skills.
Nice To Haves
- Certification in Healthcare Compliance (CHC) preferred.
Responsibilities
- Ensure required elements identified within NHC’s Compliance Plan and the Federal Government Sentencing Guidelines are implemented, monitored, assessed, and adapted as needed for Medicare Parts C & D lines of service.
- Perform routine monitoring of federal and state issued documents to ensure timely communication to designated NHC parties, revision to internal work procedures, and/or implementation of new requirements with the assigned Medicare Parts C & D service lines.
- Develop, review and revise as necessary required Compliance training and education programs.
- Monitor and respond to reports received via the CTM, anonymous hotline, and any other avenue in which complaints are received related to Medicare Parts C & D service lines.
- Assist Corporate Compliance Officer & Operations in responding to allegations of fraud, waste, and abuse as well as developing & overseeing necessary corrective actions.
- Regularly review operational & clinical metric reports and participate in regularly scheduled meetings with operations and related parties for oversight of the Medicare Parts C & D lines of service.
- Provide compliance oversight of First Tier, Downstream, and Related Entities (FDRs) who provide services to NHC Advantage and/or Network Pharmacy.
Benefits
- health, dental, vision, life, disability insurance, paid time off, 401 (k) with generous company match, stock options
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
