Description

The Shared Services Team is seeking a new team member who thrives in a highly collaborative team-oriented environment.  The Compliance Analyst position requires supporting the Claims Division with all facets of Medicare and SCHIP reporting processes and assistance with general claims compliance requirements (as needed).

Responsibilities

Meet the Compliance Guidelines of CMS (Centers for Medicare Services) through knowledge of “5 Fields” for eligibility determination; as well as ICD Codes, TPOC (Total Payment to Claimant) and ORM (Ongoing Responsibility for Medial)
Maintain a close relationship with vendor partner to access reports and data in vendor dashboard and MSP Navigator and Analyzer tools.
Complete Missing Section 111 data, compare missing eligibility information to RMA
Monitor CP Link, present claims for review when necessary, forwarding and following up on Treasury Notices with Examiners.
Address any CMS alerts that arise.
Update Arch’s CMS/SCHIP Policies & Procedures Manual and Workflows as needed.
Assist Compliance team with other aspects of Claims Compliance as necessary.

Experience and Required Skills

Hands-on experience and strong aptitude with Microsoft Excel, PowerPoint and Word
Exceptional communication (written and verbal), influencing, negotiating, listening, and interpersonal skills to effectively develop productive working relationships with internal/external peers and other professionals across organizational lines
Strong problem-solving, analytical, organizational, and time management skills 
Advanced attention to detail ensuring work product accuracy 
Applies critical thinking and produces information to identify key issues 

Education

Bachelor's degree preferred
In-house and insurance/reinsurance experience; either or both preferred
1-3 years of liability and/or workers’ compensation claims handling experience required
3-5 years plus experience working preferably with insurance compliance/Medicare issues or equivalent.