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Mutual of Omaha Insurance

Medicare Compliance Consultant

Mutual of Omaha Insurance - Nebraska City, NE

Medicare Compliance Consultant

Job no: ******

Work type: Full Time Regular

Location: Nebraska

Categories: Legal/Compliance

Responsible for coordinating and conducting regular internal/delegated entity audits to ensure the plan meets the regulatory and compliance requirements of federal and state laws. Supports the companys compliance investigations program and activities to ensure effective, appropriate and timely investigations of reports of potential non-compliance across the company.

Essential Job Functions:

* Demonstrates strong understanding of Center for Medicare and Medicaid Services (CMS) requirements and regulations related to Medicare Advantage and Medicare Part D operations and compliance; has extensive familiarity with relevant resources and is available to provide technical assistance and guidance to business units within the plan and external entities.

* Working independently, conducts audits of departments involved in the delivery and/or administration of Medicare Advantage and Medicare Part D plans for compliance with the Center for Medicare and Medicaid Services (CMS).

* Assist in detecting, preventing, and correcting Fraud, waste and abuse.

* Assists management in developing compliance audit instruments and protocols. Revises Medicare Compliance departmental policies and procedures to comply with regulatory changes.

* Prepares and analyses reports based on audit results, including recommendations for corrective action. Maintains records of audits and follow-up of action taken.

* Under managements guidance, communicates with regulatory agencies to clarify requirements, address reporting and filing issues.

* Participates in disseminating Center for Medicare and Medicaid Services (CMS) communications and in maintaining Compliance Monitoring Calendar.

* Monitors that policies and procedures of operating areas relative to the Medicare program are regularly updated and reflect actual operations.

* Maintains awareness of industry trends and legislative impact on policies, products and services.

* This position requires up to 33% travel, which may include flying and/or driving and some overnight stays.

* This position requires sitting over 66% of the time.

* This position requires Visual Acuity at 20 inches (or less) over 66% of the time.

Minimum Qualifications:

* Bachelor degree with 3-5 years experience with Managed Care organization or health plan.

* Strong knowledge of Medicare Advantage products and plans

* Excellent written and verbal communication skills.

* Detail oriented and have strong organization and time management skills.

* Proficient in Microsoft Office products

* Experience performing multiple projects and working with a team member.

Preferred Qualifications:

* Knowledge of Managed Care payment methodologies

* Demonstrated experience in process improvement

* 3 years of management or supervisory experience

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact a Human Resources Representative at 1-************. We are available Monday through Friday 7 am to 4 pm CST.

For all other inquiries, contact our HR Helpline at 1-************, option 4.

Mutual of Omaha and its affiliates are an Equal Opportunity /Affirmative Action Employer, Minorities/Female/Disabled/Veteran

To All Recruitment Agencies: We do not accept unsolicited agency resumes and we are not responsible for any fees related to unsolicited resumes.

Advertised: May 4, 2018 09:00 AM Central Daylight Time

Applications close: May 21, 2018 11:55 PM Central Daylight Time

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12 days 14 hours ago

Mutual of Omaha Insurance


Medicare Compliance Consultant Mutual of Omaha Insurance - Nebraska City, NE, United States


Location: Nebraska City, NE

Company Profile:
Mutual of Omaha was founded on a simple principle: to provide financial security and care in difficult times. For more than 100 years, we have put that principle into action not only through our products and services, but also through our involvement in the community.Mutual of Omaha has been in business for more than a century, providing dependable, affordable products and services that help our customers through life’s transitions. Through a dedicated network of financial advisors and insurance agents/producers, Mutual of Omaha offers insurance and financial products to individuals, families and employers.