Medicare Compliance Director

Under the direction of the Vice-President of Claim Operations, manages the Broadspire SCHIP Production Operations & MSP Compliance. Ensures that quality products and services are delivered. Serves as the primary business process subject matter expert on Medicare Compliance.

Salary Details:

$69,139.98 - $126,418.69/Annually

• Leads and manages a unit of individuals who provide services supporting the various aspects of SCHIP data transmissions and MSP Compliance.
• Manages the Broadspire CMS Account managers and error report processors who are responsible for assisting account management and carrier relations with understanding of the Medicare SCHIP legislation and the client's initial and ongoing responsibilities and time lines for registering as RREs with CMS.
• Obtaining and maintaining the RREs information including but not limited to their RRE registration ID's, their contact and address information, their vendor information, and their specific data process flow.
• Obtaining from our clients and maintaining Insured and self insured information necessary to define responsible RRE through-out the file of a claim and/or program.
• Working with our vendors to define control and error reports and establishment of the distribution, scheduling and turn around of such reports.
• Manages the requirements gathering for new client implementation, any existing client change requests and any terminating client data needs related to SCHIP
• Serves as the business subject matter expert and works with the ICT staff, vendors, and clients to develop requirements, document process flows, test and implementation of all internal and external aspects of the Medicare process.
• Oversees the performance, accuracy, and timeliness of data being supplied for SCHIP reporting
• Monitors department performance, reports on statistics, and recommends and implements changes to continually improve work productivity.
• Participates in new client RFPs and presentations etc. as needed. Also participates in Take over and Reverse Take over projects.
• Establishes performance objectives and personal development targets and regularly provides coaching for performance improvement and development
• Interacts with business partners, customers, ICT and vendors regularly to develop and refine requirements, gain agreement on solutions and deliverables, report on progress, monitor satisfaction, identify and resolve concerns and conflicts.
• Responsible for the services provided by external vendors providing data transmissions to multiple parties and that return data to Broadspire.
• Works with the Sales Department, Account Management, Statistical & Claim Data , Claim Technical, RMIS, ICT, Teleplus & Acct Services and Claim Data Operations on a constant basis to ensure superior service and data accuracy in all applications.
• Keeps Senior Management informed verbally and in writing of activities and problems within assigned area of responsibility; refers matters beyond limits of authority and expertise to VP of Claim Operations for direction.
• Performs other related duties as required or requested.

• Completion of a college or university degree in information systems, business administration or insurance or related field and 7 years experience in insurance or information systems, and 5 years project or general management experience or an equivalent combination of training and experience that would produce the following knowledge, abilities, and skills.
• Demonstrates a sound knowledge of basic business principles.
• Demonstrates the ability to plan projects and manage resources to ensure successful results.
• Learns and changes quickly to respond to changing opportunities in the marketplace.
• Understands the impact of decisions, actions, and technology on Broadspire's and customers business systems.
• Excellent understanding of process and systems flow.
• Displays excellent interpersonal skills.
• Displays excellent presentation and training skills.
• Displays ownership in business relationships and assignments.
• Ability to clearly present information through the spoken or written word; reads and interprets complex information; talk with customers or clients; listens well.
• Ability to stay well informed of current industry trends; learn and apply new concepts and identifies own areas of opportunity and sets and monitors self development goals.
• Ability to demonstrate a high level of service delivery; do what is necessary to ensure customer satisfaction; deals with service failures and prioritizes customer needs.
• Ability to challenge conventional practices; adapt established methods for new uses; pursues ongoing system improvement; develops new ideas to create novel solutions to problems; evaluates new technology as potential solutions to existing problems.
• Demonstrates or models behavior that rallies others around a common cause and builds a shared sense of purpose. Coaches and mentors others to develop their business competencies and technical skills. Provides support without removing responsibility.
• Ability to develop rapport with others and recognize their concerns and feelings; builds and maintains long term associations based on trust; helps others.
• Automotive and/or air travel (20% - 25% of the time) may be required in the first year of employment.
• Must complete continuing education requirements as outlined by Crawford Educational Services

#LI-EM3

• Pay and incentive plans that recognize performance excellence
• Benefit programs that empower financial, physical, and mental wellness
• Training programs that promote continuous learning and career progression while enhancing job performance
• Sustainability programs that give back to the communities in which we live and work
• A culture of respect, collaboration, entrepreneurial spirit and inclusion