Compliance Analyst
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Job Location:
Pasadena, TX - USA
Monthly Salary:
$ 73000 - 77000
Posted on:
20 hours ago
Vacancies:
1 Vacancy
Job Summary
Compliance Analyst Pasadena CA Direct Hire
Salary: $73000$77000
Schedule: On-site
Openings: 3
Overview
We are seeking three Compliance Analysts with CMS regulatory compliance experience in a Medicare Advantage Prescription Drug (MAPD) environment. Ideal candidates have strong auditing skills across Claims UM and CR operations with a clear understanding of federal regulatory requirements.
Key Responsibilities
Required Experience
Skills & Attributes
Preferred
Salary: $73000$77000
Schedule: On-site
Openings: 3
Overview
We are seeking three Compliance Analysts with CMS regulatory compliance experience in a Medicare Advantage Prescription Drug (MAPD) environment. Ideal candidates have strong auditing skills across Claims UM and CR operations with a clear understanding of federal regulatory requirements.
Key Responsibilities
- Conduct regulatory audits of Claims UM and CR functions to ensure compliance with CMS Medicare Advantage & Part D requirements.
- Interpret and communicate CMS regulatory updates manuals and operational guidance.
- Perform internal monitoring issue tracking corrective action follow-up and support FWA (Fraud Waste & Abuse) prevention activities.
- Provide regulatory guidance to internal departments and external partners.
- Participate in CMS trainings/webinars as needed.
- Perform CMS data submission quality checks and assist in preparation for CMS reviews and audit activities.
- Support oversight of first tier downstream and related entities (FDRs).
Required Experience
- Minimum 2 years Medicare compliance experience or 2 years working directly with CMS programs in a MAPD setting.
- Hands-on experience with:
- CMS Medicare Managed Care Manuals / Part C & D
- Claims UM and CR auditing
- Compliance monitoring and regulatory interpretation
- 35 years health plan experience preferred (Medicare Advantage).
Skills & Attributes
- Strong working knowledge of CMS and Medicare regulatory requirements.
- Excellent auditing analytical and documentation skills.
- Ability to work independently meet deadlines and maintain strict confidentiality.
- Strong communication and interpersonal skills.
- Proficient with MS Office (Word Excel database tools).
Preferred
- Certified in Healthcare Compliance (CHC)
- Prior Medicare audit experience
Required Experience:
IC
Key Skills
- Abinitio
- Apprentice
- Dermatology
- Cost Estimation
- Data Networking
- Liaison
