Policy Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Analyze and execute policy guidelines concerning Coordination of Benefits and MSP recovery tasks under the BCRC contract.

• Evaluate and provide recommendations on updates to Standard Operating Procedures and modifications to BCRC letters.

• Engage in key functional user groups.

• Offer technical expertise and direction to guarantee adherence to relevant statutes, regulations, and CMS policies.

• Collaborate with Training Staff, SOP Specialists, Compliance Officers, and auditors to ensure consistent procedures and regulatory compliance.

• Coordinate with CMS regarding policy-related inquiries and issues.

• Contribute insights on Technical Direction, Letters, Joint Operating Agreements (JOAs), and CMS Change Requests.

• Detect trends and suggest enhancements to processes.

• Strive for continuous process improvements while ensuring compliance with the BCRC Statement of Work.

• Maintain confidentiality and uphold standards of privacy, data integrity, and security.

• Comply with qualitative and quantitative benchmarks set to fulfill contractual obligations and adapt to evolving business requirements.

• Report unsafe conditions or practices to the appropriate supervisor and human resources.

⛳️ Requirements

• Must be eligible to obtain and maintain the necessary customer clearance.

• Must successfully pass a customer background check.

• Requires U.S. Citizenship or Permanent Resident (Green Card) status.

• Ability to effectively multitask in a fast-paced and dynamic environment.

• Strong analytical skills to assess issues and develop suitable solutions.

• Extensive experience in interpreting CMS Coordination of Benefits (COB) and Medicare Secondary Payer (MSP) recovery policies.

• Comprehensive knowledge of CMS Internet-Only Manual (IOM) guidelines for MSP Recovery and Medicare laws and regulations, including HIPAA.

• Operational knowledge of Medicare policies, procedures, and MSP-related systems such as ReMAS, CWF/HIMR, ECRS, HIGLAS, BCRS, and image repositories.

• Proficient in Microsoft Office Suite, including Word, Excel, PowerPoint, and Access.

• Strong organizational, analytical, problem-solving, and critical-thinking skills.

• Excellent written and verbal communication abilities.

• Capacity to convey complex information succinctly to individuals with varying expertise levels.

• Proven ability to foster teamwork and coordinate efforts.

• Demonstrated skill in constructively resolving conflicts, grievances, and disputes.

• Experience in developing, documenting, and implementing approved procedural changes.

• Strong project and time-management capabilities.

• Ability to manage confidential and sensitive information with discretion.

• Capable of working independently as well as collaboratively within a team.

• Willingness to travel and work between 6:00 a.m. and 7:00 p.m. as required.

• Bachelor’s degree along with a minimum of 8+ years of relevant experience in MSP Recovery, or equivalent combination of education and experience.

🏝️ Benefits

• Medical insurance

• Dental insurance

• Vision insurance

• Company life insurance

• Short-Term and Long-Term Disability Insurance

• 401(k) with immediate vesting

• Professional Development Assistance

• Legal Aid Assistance Program

• Family Planning / Fertility Assistance

• Personal Time Off

• Observance of Federal Holidays

• Employee Assistance Program (EAP)

• Training and Development Opportunities