Medicare Compliance Consultant

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Amerisure is an insurance organization charged with creating exceptional value for its Partners For Success® agencies, employees and policyholders. As a property and casualty insurance company, Amerisures promise to our partner agencies and policyholders begins with a comprehensive line of insurance products designed to protect businesses, as well as the health and safety of every employee. Amerisure is an A.M. Best œA (excellent) rated company and services mid-sized commercial enterprises focused in construction, manufacturing and healthcare. We are ranked as one of the top 100 Property & Casualty companies in the United States, with more than $835 million in Direct Written Premium and $937 million in surplus.

Amerisure is currently recruiting for a Medicare Compliance Consultant whom can sit in any of our CSC offices or remotely. The ideal candidate will possess the following skill set. 

Summary Statement

Manage and facilitate Medicare compliance related activities for the claims department, including Medicare Secondary Payer Act compliance and regulatory reporting processes. Monitor regulatory changes and recommend and develop processes for communicating changes throughout the organization. Collaborate with organization stakeholders to modify or develop appropriate policies, procedures or controls to ensure compliance.

Essential Tasks/Major Duties

• Serve as subject matter expert for Amerisure Claims Medicare Compliance Program including Medicare Secondary Payer (MSP) Act and mandatory reporting requirements under MMSEA Section 111.
• Develop, implement and manage a consistent and repeatable process for section 111 mandatory insurer Medicare reporting.
• Develop, implement and manage procedures and guidelines for conditional payment resolution as well as future medical allocations that comply with the MSP Act for claims involving Medicare beneficiaries.
• Provide training and guidance to claims staff on Medicare compliance procedures and guidelines.
• Monitor and analyze regulatory reporting to and from Centers for Medicare Services (CMS) to ensure reporting compliance.
• Facilitate error corrections when necessary to ensure compliance with Medicare reporting requirements.
• Assist in selection, management, and oversight of Medicare compliance vendors including MSP compliance vendors and Section 111 reporting vendors. 
• Collaborate with Liability and Workers Compensation Line of Business technical teams to provide training and guidance on Medicare compliance issues. 
• Collaborate with Claims Operations team on overall claims compliance programs.
• Collaborate with other departments including information technology, corporate legal and other stakeholders to ensure appropriate policies, procedures and controls are in place.

Knowledge, Skills & Abilities

• Bachelors degree in insurance or related field required.
• 7 years of experience in the insurance industry handling casualty claims or comparable experience.
• Proficient knowledge of Medicare Secondary Payer Act and MMSEA Section 111 reporting requirements preferred.
• Proficient computer skills required including Microsoft Office Suite.
• Demonstrated successful ability to build positive relationships and partnerships within department, across the organization and with external customers.
• Excellent organizational skills, including ability to multi-task and prioritize workload.
• Strong analytical skills and attention to detail.
• Excellent verbal and written communication skills with the ability to interact with internal and external customers.
• Ability to travel up to 10%.

WHEN APPLYING PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER SUCH AS CHROME, FIREFOX, ETC.

Just as we are committed to creating exceptional value for our Partners For Success® agencies and policyholders, Amerisure also remains committed to being an employer of choice. We reinforce this commitment by adhering to an Employee Value Proposition that, in part, is provided through a competitive total rewards package. Amerisure offers a Compensation & Benefits Package that includes competitive base pay, performance based incentive pay, comprehensive health & welfare benefits, 401(k) savings plan, and profit sharing.  In addition to generous paid time off programs, we allow our employees flexible and remote work arrangements. If you strive for excellence and are committed to personal and professional growth, Amerisure is looking for you.  

Amerisure Insurance provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Amerisure Insurance complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. Amerisure Insurance expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Amerisures employees to perform their job duties may result in discipline up to and including discharge.