Health and Medicare Insurance Compliance Manager

Ideal Concepts, Inc. - Allentown, PA (30+ days ago)4.2


Job Summary

The Compliance Manager is responsible for programs, and policies that ensure all practices are in compliance with Ideal Concepts’ Standard Operating Procedures, as well as Carrier requirements, HIPAA, CMS and other regulatory standards. This role will manage the department, monitor operations and determine compliance standards as well as solutions to common issues.

Responsibilities and Duties

The Compliance Manager will:

  • Manage the compliance department responsible for the design and development of programs, policies, and practices that ensure the organization complies with federal, state, local and carrier regulatory requirements.
  • Supervise and lead compliance staff.
  • Ensure compliance with Ideal Concepts’ SOP.
  • Identify and resolve any compliance issues and report them to the management teams.
  • Prepare compliance reports to present to Senior Management.
  • Generate Responses to the better business bureau and state DOI as necessary.
  • Prepare compliance status reports for practice managers and regulatory agencies as required.
  • Review agent phone calls and emails for compliance violations.
  • Stay current on trends in healthcare and Medicare, reporting, and regulatory compliance.
  • Consult with managers on upcoming regulatory changes that will affect their business.
  • Update operating manuals and procedural documents when regulations change.
  • Update Standard Operating Procedures as necessary to ensure best practices.
  • Analyze and interpret compliance trends to ensure best practices are in place.
  • Field client and carrier complaints.

Qualifications and Skills

The ideal candidate will have the following skills and experience:

  • A Bachelor’s degree is required.
  • A minimum of 5 years related Healthcare and Medicare Compliance experience.
  • A minimum of 3 years managing a department.
  • Expert knowledge of Medicare Advantage, Medicare part D and Medicare supplements.
  • Previous experience serving as Compliance Officer is a plus.
  • Ability to adapt to new job requirements as needed.
  • Experience with CMS, DOI, Carrier and Federal regulations.
  • Excellent knowledge of office practices, operational requirements, and office computing required.
  • Proficient in Microsoft Office products, especially, Excel, Word, Outlook and PowerPoint.
  • Strong time management, prioritization and organization skills.
  • Advanced organizational, communication and interpersonal skills.
  • Insurance license and AHIP certification preferred.

Benefits

  • 15 days of PTO
  • 8 paid pre-determined holidays
  • Full health benefits
  • Employee 401k Plan
  • Technology focused, fast paced working environment
  • Professional team atmosphere with motivated, career-driven professionals as co-workers
  • Expansion and growth with one of the top insurance technology companies in the nation

Job Type: Full-time

Job Type: Full-time

Experience:

  • management: 1 year
  • Medicare and Health Insurance Compliance: 1 year

Education:

  • Bachelor's

License:

  • AHIP
  • Health and Life Insurance