Compliance AnalystNew Leaf Staffing • Pasadena, Texas, USA
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Compliance Analyst
New Leaf Staffing • Pasadena, Texas, USA
[job_card.30_days_ago]
[job_preview.job_type]
- [job_card.full_time]
- [job_card.permanent]
[job_card.job_description]Minimum 2 years Medicare compliance experience or 2 years working directly with CMS programs in a MAPD setting. Hands-on experience with : Claims UM and CR auditing Compliance monitoring and regulatory interpretation 35 years health plan experience preferred (Medicare Advantage). Strong working knowledge of CMS and Medicare regulatory requirements. Excellent auditing analytical and documentation skills. Ability to work independently meet deadlines and maintain strict confidentiality. Strong communication and interpersonal skills. Proficient with MS Office (Word Excel database tools). Certified in Healthcare Compliance (CHC) Prior Medicare audit experience
Compliance Analyst Pasadena CA Direct Hire
Salary : $73000$77000
Schedule : On-site
Openings : 3
Overview
We are seeking three Compliance Analysts with CMS regulatory compliance experience in a Medicare Advantage Prescription Drug (MAPD) environment. Ideal candidates have strong auditing skills across Claims UM and CR operations with a clear understanding of federal regulatory requirements.
Key Responsibilities
- Conduct regulatory audits of Claims UM and CR functions to ensure compliance with CMS Medicare Advantage & Part D requirements.
- Interpret and communicate CMS regulatory updates manuals and operational guidance.
- Perform internal monitoring issue tracking corrective action follow-up and support FWA (Fraud Waste & Abuse) prevention activities.
- Provide regulatory guidance to internal departments and external partners.
- Participate in CMS trainings / webinars as needed.
- Perform CMS data submission quality checks and assist in preparation for CMS reviews and audit activities.
- Support oversight of first tier downstream and related entities (FDRs).
Required Experience
CMS Medicare Managed Care Manuals / Part C & D
Skills & Attributes
Preferred
Required Experience :
IC
Key Skills
Abinitio,Apprentice,Dermatology,Cost Estimation,Data Networking,Liaison
Employment Type : Full Time
Experience : years
Vacancy : 1
Monthly Salary Salary : 73000 - 77000
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