Medicare Compliance Population Health RN

Crossover Health • Minot, ND

1d

About The Position

About Crossover Health Crossover Health is creating the future of health as it should be. A national, team-based medical group with a focus on wellbeing and prevention that extends beyond traditional sick care, the company delivers an entirely new model of healthcare—Primary Health—built on the foundation of trusted relationships, an interdisciplinary care team approach, and outcomes-based payment. Crossover’s Primary Health model integrates primary care, physical medicine, mental health, health coaching, care navigation and more, and delivers care in surround-sound—in-person, virtually and via asynchronous messaging. Together we are building a community of members that embraces healthcare as a proactive part of their lifestyle. Job Summary About Crossover Health Crossover makes remarkable health possible by bringing people, their doctors, data, and benefits together under one connected system of health. We’ve built an entirely new category of primary care providing one simple place to go for trusted care—in person, online, anytime. We are working with the most innovative employer partners to integrate disconnected health and wellness benefits with tech-enabled services which allows our partners to increase access to care, decrease spend, and deliver an unrivaled experience for employees near and far. The Medicare Compliance Population Health RN supports the development and ongoing effectiveness of Crossover Health’s Medicare Advantage Compliance Program by ensuring compliance with Medicare Part C requirements, CMS regulations, and cOS standards. This role oversees regulatory updates, policy development, workflow improvement, and quality initiatives; conducts compliance training and education; performs internal audits and supports external reviews; identifies and mitigates compliance risks; and serves as a liaison with Medicare Advantage Organizations. The RN acts as a clinical and population health resource for onsite and national teams, supports outreach initiatives, contributes to reporting and QBRs, and partners with leadership to ensure compliant, efficient, and high-quality population health operations.

Requirements

• Graduate from an accredited school of nursing
• Certification in Healthcare Compliance (CHC) or equivalent strongly preferred.
• Minimum 3–5 years of healthcare compliance experience, with direct exposure to Medicare Advantage programs.
• Familiarity with physician practice operations, clinical workflows, and CMS regulations.
• Strong communication, analytical, and leadership skills.
• Minimum 3 years of clinical experience
• Current Registered Nurse license in the state you are practicing

Nice To Haves

• Bachelor of Science Degree in Nursing (BSN)
• Secondary degree in healthcare administration, public health, or related field (Master’s preferred).
• 1 year of Crossover Health experience as a nurse
• Knowledge of Apple and Google-based technology or client technologies such as Microsoft or HP Passion for delivering a best-in-class patient care experience in an integrated patient-centered primary care model
• Creative, flexible and easily adapts to changing priorities
• Energetic, takes initiative and able to work in a team environment as well as autonomously when needed
• Embraces new ways of delivering healthcare
• Deep understanding of clinical documentation and coding practices
• Ability to translate complex regulations into practical workflows
• Proactive problem-solving and risk assessment
• High ethical standards and discretion

Responsibilities

• Compliance Program
• Support the development of Crossover Health’s Medicare Advantage Program.
• Monitor effectiveness of Crossover Health’s Medicare Advantage Compliance Program.
• Regulatory Oversight
• Manage Crossover’s compliance with Medicare Part C requirements, including risk adjustment and encounter data reporting.
• Monitor and implement applicable CMS updates and Medicare Advantage regulations affecting Crossover Health’s operations.
• Participate in quality improvement programs to ensure the practice is performing efficiently and in accordance with Crossover’s policies.
• Policy Development & Implementation
• Assist with ongoing development and maintaining compliance policies.
• Support protocols for documentation, coding, billing, and patient communication that meet CMS standards.
• Assist with ongoing workflow design, process improvement, quality measurement, and issue resolution.
• Training & Education
• Conduct regular compliance training for physicians, clinical staff, administrative personnel and governing board.
• Educate staff on fraud, waste, and abuse (FWA) prevention and reporting.
• Lead the training of new team members in cOS, outreach workflows, goals & expectations.
• Provides strategic advice and recommendations to the leadership team in the development, implementation, and evaluation of new or modified cOS policies, practices, and procedures.
• Audit & Monitoring
• Perform internal audits of clinical documentation, coding, and billing practices.
• Coordinate with and support external auditors during compliance reviews.
• Audit outreach to ensure that it is up to Crossover standards.
• Risk Management
• Identify compliance risks related to Medicare Advantage participation and implement mitigation strategies.
• Investigate potential violations and add support to corrective action plans.
• Collaboration & Reporting
• Serve as the liaison between Crossover Health and the Medicare Advantage Organization regarding compliance matters and contract compliance.
• Report compliance activities and findings to executive leadership.
• Manage, maintain and update cOS resources.
• Lead onsite cOS efforts and be a cOS advocate for both the client and for the onsite and national teams.
• Demonstrate proficiency in the use of healthcare analytic tools, systems, and analysis.
• Clinical support and lead nurse resource for onsite team.
• Contributes to QBR presentations and discussions.
• Partners with Onsite and National Leadership and members of the Population Health team to ensure that care teams know how to perform cOS outreach and how to access their resources.
• Outreach
• Supports population health programs and clinic outreach initiatives.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 1,001-5,000 employees