Senior Compliance Administrator, Medicare Claims – Payment Integrity

This is a fully remote position, open to applicants in Florida, +2 more states.

📋 Description

• Acts as an individual contributor and subject matter expert dedicated to facilitating the daily operations of the Medicare Compliance Advisory program in accordance with CMS requirements and relevant federal and state regulations.

• Provides reliable advisory support to business and compliance leadership by offering regulatory guidance, performing research and analysis, monitoring issues, enhancing audit readiness, and assisting with compliance workplan activities.

• Collaborates closely with the Sr. Manager of Medicare Compliance Advisory.

• Implements the Medicare Compliance Program in alignment with CMS and applicable federal and state regulations, focusing on the prevention, detection, and correction of noncompliance and Fraud, Waste, and Abuse (FWA).

• Completes assignments in a timely, accurate, and well-documented manner.

• Acts as a compliance advisor and subject matter resource for Medicare programs by interpreting CMS regulations and guidance, translating requirements into clear, actionable business insights, and advising leadership on compliance implications and implementation needs.

• Assists with the intake, tracking, and resolution of compliance issues, including documenting findings, evaluating risk, and recommending corrective actions.

• Contributes to monitoring and oversight activities by identifying regulatory risks and trends while supporting the resolution of identified issues.

• Prepares draft responses and supporting materials for regulatory inquiries, audits, data requests, and internal compliance reviews.

• Maintains accurate and comprehensive documentation of compliance activities, including issue logs, regulatory references, self-disclosures, and supporting evidence.

• Works collaboratively with cross-functional business partners to clarify regulatory requirements and facilitate the implementation of compliant processes.

• Timely escalate compliance risks, gaps, or delays to support effective risk management and decision-making.

• Contributes to audit readiness through documentation support, process validation, and issue resolution activities.

• Identifies opportunities for process improvement and supports initiatives aimed at enhancing compliance controls, standardization, and operational efficiency.

• Assists in compliance training and educational initiatives, ensuring awareness of Medicare regulatory program requirements, standards of conduct, and reporting obligations.

⛳️ Requirements

• Bachelor’s degree in a related field (e.g., healthcare administration, public health, policy) or equivalent experience is required.

• A minimum of 5 years of experience in Compliance, regulatory, operations, or risk management within a regulated industry (e.g., healthcare, managed care, insurance, or public sector) is required.

• Proven experience in interpreting and applying complex regulatory frameworks and compliance program requirements in a regulated environment into clear, actionable guidance for business stakeholders is required.

• Experience in leading cross-functional initiatives or large-scale compliance efforts is required.

• Background in conducting risk assessments, analyzing data, and utilizing structured problem-solving approaches to identify compliance risks and recommend mitigation strategies is required.

• Experience in effectively communicating and managing relationships across stakeholders, including presenting complex compliance concepts to diverse audiences, is required.

• Demonstrated experience in influencing cross-functional partners and driving outcomes in a matrixed environment without direct authority is required.

• Experience supporting managed care, Medicare Advantage/Part D, or Dual Eligible (DSNP) programs.

• Foundational knowledge of Medicare regulations, including CMS guidance and compliance expectations (e.g., Parts C & D).

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K and stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work arrangements, offering remote, hybrid, field, or office work schedules.