Medicare Compliance Specialist, remote

Company: Brigham and Women's Hospital
Location: Somerville
Posted on: May 28, 2023

Job Description:

Job Description - Medicare Compliance Specialist, remote (3242622) Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated. We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more. - Reporting to the Director, Legal, Regulatory Affairs & Compliance, the Medicare Compliance Specialist is responsible for the following functions: -
--- Conduct audits and monitoring activities. -
--- Initiate and remediate CAPs.
--- Disseminate HPMS memos.
--- Work with internal business owners and external FDRs to remediate issues.
--- Serve as a gatekeeper for HPMS access.
--- Update policies and procedures.
--- Prepare reports to the Compliance Committee.
--- Lead external CMS audit coordination efforts. -
--- Report data to CMS.
--- Identify process improvement opportunities.
--- Build strong relationships with internal and external stakeholders.
--- Other duties as assigned with or without accommodation.
Working Conditions and Physical Effort -
--- Work is normally performed in a typical remote work environment.
- Knowledge and Education Required:
--- Bachelors Degree or substitution of 5+ years of work experience. Experience Required:
--- 3+ years of experience in the health care industry
--- Experience in performing highly analytical and critical thinking work
Preferred/Desired:
--- Knowledge of Medicare Advantage -
--- Knowledge/experience with federal, state and payer-specific regulations
--- Experience in health care compliance
--- Experience in auditing
Skills/Competencies --- Demonstrate MGB Health Plan's core brand principles of always listening, challenging conventions, and providing value. -
--- Strong aptitude for technology-based solutions. -
--- Ability to inject energy, when and where it's needed.
--- Respect the talent and unique contribution of every individual and treat all people in a fair and equitable manner. -
--- Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback.
--- Be accountable for delivering high-quality work. Act with a clear sense of ownership.
--- Bring fresh ideas forward by actively listening to and working with employees and the people we serve.
--- Excellent verbal and written communication skills
- Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. -We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Primary Location MA-Somerville-MGB Health Plan at Assembly Row Work Locations MGB Health Plan at Assembly Row Job Professional/Managerial Organization Mass General Brigham Health Plan Schedule Full-time Standard Hours 40 Shift Day Job Employee Status Regular Recruiting Department MGB Health Plan Regulatory Affairs

Keywords: Brigham and Women's Hospital, Somerville , Medicare Compliance Specialist, remote, Other , Somerville, Massachusetts