Serves as the Compliance Officer; reports compliance issues to the Chief Clinical Officer (CCO). Maintains current knowledge of Medicare Conditions of Participation (COPs) and the Community Health Accreditation Program’s (CHAP) standards to ensure that the organization complies with state, federal, and accreditation guidelines.

The Medicare Compliance Analyst & Support Specialist position is an essential role within Fallon Health’s Medicare compliance program and includes activities such as the collection and review of data universes for accuracy to protocols, data analysis to identify risks and trends, developing data visualization and dashboards to portray information to Fallon Health Leadership up to the Audit & Compliance Committee of the Board.

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. Performs retrospective file reviews for various Behavioral Health and Care Management populations (i.e., BHT (Autism spectrum), Eating Disorders, complex and high-risk children), turnaround time for inpatient/outpatient BH services, Medicare, Cal MediConnect, Medi-Cal, Complex Care Management, California Children's Services, Inland Regional Center Early Start) to identify significant and problematic BHCM quality issues and concerns.

Provides leadership and direction for departments on Coding Integrity strategies by state and federal regulatory guidelines, CMS and Medicare Administrative Contractor rules and regulations, Medicaid-specific rules and regulations, and Managed Care contract terms.

Reviews potential issues of non-compliance report to Medical Pharmacy Leadership, Medicare Compliance Officer and coordinate investigation, remediation and provides appropriate guidance to operational areas.

8+ years Healthcare Compliance experience with extensive experience with Medicare products, including Medicare Part D. Compliance, Medicare, Medicare Part D (MedD), Supervisory.

Acts as an advisor and consultant in the establishment of operational policies of the practice to include: (1) Purchasing and capital allocations; (2) Managed care plan participation; (3) Budget and practice expenses; (4) Medicare/Medicaid participation; (5) Billing and collection of professional fees; (6) Personnel management and related policies; (7) Risk management and quality assurance; and (8) Coding compliance.

Maintains knowledge of and compliance with current Medicare/Medicaid, state/federal rules and regulations for professional (palliative care, advanced disease management, transitional and chronic care) services.

Identifies/reviews services requiring pre-authorization/pre-certification by Medicare, Medicaid, Commercial, and Managed Care payers, to ensure provider eligibility requirements are met prior to receiving service.

Knowledge of federal and state regulations, filling and compliance requirements, both adopted and pending, affecting employee benefits programs including ERISA, ACA, COBRA, FMLA, DC PFL, ADA, Section 124, workers compensation, Medicare, and Social Security, HIPPA and DOL requirements.

The Choice Inc is seeking an immediate Total Rewards Manager for our client, a prominent, global green energy association. The Total Rewards Manager will serve as a subject matter expert and liaison to staff, vendors and customers for compensation, benefits and HRIS related matters.

Reporting directly to the VP of Human Resources, this manager will work to revamp the compensation and benefits offerings of the organization. Benefits certification preferred (i.e. CEBS, PHR) Experience working in a HRIS. Paycom experience preferred.

6 years of experience; at least 3 years of experience with compensation, benefits or benefits administration. This is an ASAP, full-time hours contract opening, but for the right person, it could become a permanent hire opportunity.

The Inpatient Coder assigns the principal diagnosis, comorbidities, complications and chronic conditions for Hackensack Meridian Health (HMH) Inpatient cases across the network to the highest specificity utilizing currently mandated coding systems in accordance with Centers for Medicare and Medicaid Services (CMS) and other coding compliance regulations.

Experience in managed care, Medicare and federal regulations, quality improvement, and compliance oversight. MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.