Description

UPMC Healthplan's Medicare Compliance team is seeking an Administrator, Medicare Compliance!

The position incumbent will report directly to the Director of Medicare Compliance. The Administrator will assist the Manager in coordinating the Health Plan's efforts to ensure compliance with laws, regulations, and policies affecting the Medicare line of business. We're seeking someone with a background in Medicare and/or regulatory compliance.

Currently, this role is REMOTE, but there is a possibility of it moving to HYBRID (work-from-home & in-office). 

Responsibilities:

• Perform special projects as assigned by the Manager, Medicare Compliance.
• Maintain highly organized and very detailed on-line and hard copy filing systems to facilitate effective, accurate responses to internal and external requests.
• Coordinate participation of various health plan subject matter experts in periodiccommittee and subcommittee meetings as well as local and/or regional conferences andworkshops impacting the health plan's ability to comply with the Medicare Programrequirements.
• Responsible for the accurate communication of Medicare contractual requirements and guidance throughout the health plan, as well as the internal coordination of compliance activities.
• Responsible for the accurate communication of Medicare contractual requirements and guidance throughout the health plan, as well as the internal coordination of compliance activities.
• Participate in Policy and Procedure Subcommittee meetings.
• Partner with health plan staff in preparing accurate on-site visit reports and sending approved responses to CMS while working with supervisor to ensure any corrective action plans are sufficiently addressed by appropriate health plan departments.
• Responsible for CMS Audit preparation of materials, including binder preparation and mock audits.
• Serve as a liaison to the Centers for Medicare and Medicaid Services (CMS) ensuring in the resolution of enrollment, payment or regulatory issues.
• Coordinate with supervisor in preparation of status reports to senior management and periodic updates relative resulting from on-site visits and/or audits.
• Assist supervisor with management of third-party vendors hired to enhance program oversight.
• Work with the supervisor to coordinate the various elements of state regulatory filings, as needed..
• Assist in the development of Medicare policies and procedures.
• Conduct research on Medicare regulations.

Qualifications

• Bachelor's Degree required.
• Two to five years of demonstrated experience/knowledge of regulatory compliance or program management preferred.
• Medicare experience preferred

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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