Medicare Compliance Population Health RN

About Crossover Health

Crossover Health is creating the future of health as it should be. A national team-based medical group with a focus on wellbeing and prevention that extends beyond traditional sick care the company delivers an entirely new model of healthcarePrimary Healthbuilt on the foundation of trusted relationships an interdisciplinary care team approach and outcomes-based payment. Crossovers Primary Health model integrates primary care physical medicine mental health health coaching care navigation and more and delivers care in surround-soundin-person virtually and via asynchronous messaging. Together we are building a community of members that embraces healthcare as a proactive part of their lifestyle.

Job Summary

The Medicare Compliance Population Health RN supports the development and ongoing effectiveness of Crossover Healths Medicare Advantage Compliance Program by ensuring compliance with Medicare Part C requirements CMS regulations and cOS standards.

This role oversees regulatory updates policy development workflow improvement and quality initiatives; conducts compliance training and education;
performs internal audits and supports external reviews; identifies and mitigates
compliance risks; and serves as a liaison with Medicare Advantage Organizations. The RN acts as a clinical and population health resource for onsite and national teams supports outreach initiatives contributes to reporting and QBRs and partners with leadership to ensure compliant efficient and high-quality population health operations.
Job Responsibilities
Compliance Program
Support the development of Crossover Healths Medicare Advantage
Program.
Monitor effectiveness of Crossover Healths Medicare Advantage
Compliance Program.
Regulatory Oversight
Manage Crossovers compliance with Medicare Part C requirements
including risk adjustment and encounter data reporting.

Monitor and implement applicable CMS updates and Medicare Advantage
regulations affecting Crossover Healths operations.
Participate in quality improvement programs to ensure the practice is
performing efficiently and in accordance with Crossovers policies.

Policy Development & Implementation
Assist with ongoing development and maintaining compliance policies.
Support protocols for documentation coding billing and patient
communication that meet CMS standards.
Assist with ongoing workflow design process improvement quality
measurement and issue resolution.

Training & Education
Conduct regular compliance training for physicians clinical staff
administrative personnel and governing board.
Educate staff on fraud waste and abuse (FWA) prevention and reporting.
Lead the training of new team members in cOS outreach workflows goals
& expectations.
Provides strategic advice and recommendations to the leadership team in
the development implementation and evaluation of new or modified cOS
policies practices and procedures.

Audit & Monitoring
Perform internal audits of clinical documentation coding and billing
practices.
Coordinate with and support external auditors during compliance reviews.
Audit outreach to ensure that it is up to Crossover standards.
Risk Management
Identify compliance risks related to Medicare Advantage participation and
implement mitigation strategies.
Investigate potential violations and add support to corrective action plans.
Collaboration & Reporting
Serve as the liaison between Crossover Health and the Medicare
Advantage Organization regarding compliance matters and contract
compliance.
Report compliance activities and findings to executive leadership.

Manage maintain and update cOS resources.
Lead onsite cOS efforts and be a cOS advocate for both the client and for
the onsite and national teams.
Demonstrate proficiency in the use of healthcare analytic tools systems
and analysis.
Clinical support and lead nurse resource for onsite team.
Contributes to QBR presentations and discussions.
Partners with Onsite and National Leadership and members of the
Population Health team to ensure that care teams know how to perform
cOS outreach and how to access their resources.

Outreach
Supports population health programs and clinic outreach initiatives.

Required Qualifications
Graduate from an accredited school of nursing
Certification in Healthcare Compliance (CHC) or equivalent strongly preferred.
Minimum 35 years of healthcare compliance experience with direct exposure to
Medicare Advantage programs.
Familiarity with physician practice operations clinical workflows and CMS
regulations.
Strong communication analytical and leadership skills.
Minimum 3 years of clinical experience
Current Registered Nurse license in the state you are practicing

Preferred Qualifications
Bachelor of Science Degree in Nursing (BSN)
Secondary degree in healthcare administration public health or related field
(Masters preferred).
1 year of Crossover Health experience as a nurse
Knowledge of Apple and Google-based technology or client technologies such as
Microsoft or HP
Passion for delivering a best-in-class patient care experience in an integrated
patient-centered primary care model
Creative flexible and easily adapts to changing priorities

Energetic takes initiative and able to work in a team environment as well as
autonomously when needed
Embraces new ways of delivering healthcare
Deep understanding of clinical documentation and coding practices
Ability to translate complex regulations into practical workflows
Proactive problem-solving and risk assessment
High ethical standards and discretion

Physical Job Requirements
Requires standing walking and sitting for extended periods of time
Includes full range of body motion including potential of handling and lifting patients
Requires corrected vision hearing and speech within normal ranges
Reasonable accommodations may be made to enable individuals with

Crossover Health is committed to Equal Employment Opportunity regardless of race color national origin gender sexual orientation age religion veteran status disability history of disability or perceived disability. If you need assistance or an accommodation due to a disability you may email us at .

To all recruitment agencies: We do not accept unsolicited agency resumes and are not responsible for any fees related to unsolicited resumes.