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Compliance Specialist - Medicare/Medicaid

  • Location: Bedford, TX
  • Salary:
  • Posted: Nov 14

Click here to view a full job description and apply if qualified!





The Medicare/Medicaid Compliance Specialist monitors and ensures compliance with all applicable Federal and State requirements.  This individual is responsible for interpretation and dissemination of Medicare/Medicaid rules and requirements through monitoring and auditing activities in such a way that ensure (i) that all Medicare/Medicaid regulatory requirements and standards are understood, (ii) business processes required to address those regulations and standards are implemented and (iii) any compliance risks are communicated to the Compliance Director of Audit, FDRs, and Medicaid.  The Medicare/Medicaid Compliance Specialist may establish and maintain contact with State oversight agencies and the Centers for Medicare and Medicaid Services (CMS).
Reports to the Medicare/Medicaid Compliance Manager;
Ensure Cigna-HealthSpring compliance with Medicare/Medicaid rules and regulations;
Conduct, facilitate and participate in ongoing monitoring and auditing activities;
Manage and report CAPs in the OMT system and to leadership teams;
Manage the CAP process associated with the monitoring and auditing end-to-end – including testing to assure completion;
Validate that Medicare/Medicaid rules and regulations have been implemented correctly by Cigna-HealthSpring;
Assists in the identification of compliance risks;
Tracks due dates and coordinates the submission of reports as required;
Maintain good working relationships with internal parties to ensure open lines of communications and timely responses to compliance questions;
Review and evaluate effectiveness of Corrective Action Plans (CAPs);
Participates in special projects as needed, including training; and
Remain aware of industry changes and/or trends. 

Click here to view a full job description and apply if qualified!

From The Blog

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    I found North Texas LEAD to be a gem in the midst of a vast job seeking search. LEAD provided invaluable services with regards to interviewing techniques, resume assistance, coaching, networking and ultimately endorsement. I was interviewed by a professional and diverse panel who wholeheartedly embraces and projects diversity. Their endorsement was one which epitomizes […]

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