Job Description

Job Title: Administrator, Medicare Compliance
Job ID: 61309513
Status: Full-Time
Regular/Temporary: Regular
Shift: Day Job
Facility: UPMC Health Plan
Department: Medicare Compliance
Location: 600 Grant St, Pittsburgh PA 15219


UPMC Health Plan's Medicare Compliance Department is seeking an Administrator, Medicare Compliance!

Position incumbent will report directly to the Manager, 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.

Below are the department's strong preferences in a candidate:
-Medicare Advantage Experience
-Excellent oral and written communication skills 
-Computer operating with knowledge of Microsoft office products
-Experience in health care insurance preferred
-Clinical background preferred

  • 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.


  • Bachelor's Degree required. 
  • Two to five years of demonstrated experience/knowledge of regulatory compliance or program management preferred. 
  • Excellent organizational capabilities with ability to work effectively as a team player. 
  • Ability to continuously interact effectively and professionally with all levels of staff. 
  • Excellent written and oral communication skills. 
  • Ability to handle multiple priorities/projects in a fast-paced professional environment. 
  • Working knowledge of word-processing and database software. 
  • Demonstrated performance in meeting time-sensitive deadlines with minimal supervision

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

Salary Range: $29.80 to $50.31 / hour

Union Position: No

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