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Compliance Specialist - Medicare

BTG Jacksonville, FL

  • Expired: over a month ago. Applications are no longer accepted.
Job Description

BTG, in partnership with a top ranked healthcare company in Florida, has an immediate need for a Compliance Specialist - Medicare.

Requirements of the Compliance Specialist - Medicare

  • 5-8 years of related work experience or equivalent combination of transferable experience and education
  • Related Bachelor's degree or additional related equivalent work experience
  • Compliance or regulatory experience (e.g. training, auditing, monitoring, investigations, issue resolution, risk management, and development and monitoring of corrective actions)
  • Comprehensive knowledge of health insurance products and the associated sales, service, claims, and enrollment and billing processes
  • Knowledge of documenting walkthroughs, narratives, and flows for control identification and testing
  • Excellent verbal and written communication skills
  • Must possess strong problem solving and decision making skills
  • Must be confident interacting with people and have the ability to be persuasive
  • Proficient in Word, Excel and PowerPoint
  • Demonstrated organization, facilitation, communication and presentation skills
  • Preferred
    • Professional certification as a Certified Internal Auditor, Certified Fraud Examiner, Certified Public or Management Accountant, Certified Compliance and Ethics Professional, or Certified Information Privacy Professional
    • Project Management, Six Sigma, Lean
    • Master's degree in Business or health related field
    • Advanced Excel skills
    • Intermediate experience with MS Word and PowerPoint
    • Able to consume and make decisions with data
    • Experience working with regulatory agencies
    • Experience working with health insurance processing systems (RBMS, Siebel, Diamond, Jiva, etc.)
    • Detailed knowledge of applicable state and federal regulations and experience with the design and implementation of program safeguards to ensure organizational Medicare compliance.

Benefits of the Compliance Specialist - Medicare

  • Flexible hours, M-F
  • Medical/ Dental/ Vision
  • 401k

Responsibilities of the Compliance Specialist - Medicare

  • Collaborate with Ops compliance leadership to design and develop Medicare compliance oversight, monitoring and evaluation programs to ensure the entire Medicare organization is compliant with all applicable state and federal laws and regulations
  • Research, analyze, validate and gather business process data to assess the effectiveness of the controls to ensure compliance and identify trends. Recommend improvements to ensure compliance.
  • Track, measure, and report any identified compliance issues to Medicare leadership. Oversee the issues and work back with compliance champions for short-term and long-term resolution.
  • Consult with senior business area leaders and subject matter experts on corrective action plans to improve compliance metrics and audit findings, as required.
  • Communicate KPI and audit results monthly to both Business, Ethics, Integrity, and Compliance (BEIC) and Medicare leadership. Analyze dashboard metrics, business area reports and audit results to identify and make recommendations for operational improvements and/or corrective action measures.
  • Develop compliance dashboards, monitor and communicate results to applicable senior business area leaders and compliance leadership.
  • Consult with business areas on new projects and define compliance requirements.
  • Identify existing organizational or operational compliance risks and opportunities, work with business area leadership and subject matter experts to implement improvement and/or corrective action measures, and monitor ongoing compliance.

If you believe that your skills and experience are a match for this position, please submit your most current resume and a recruiter will be in contact. Resumes can be submitted via email to or by applying online at You may also give us a call at 904-998-9414 to speak to a recruiter.



Jacksonville, FL
32099 USA
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