Medicare Compliance Analyst - Guided Solutions

As a Compliance Analyst, you will be responsible for ensuring our compliance with Medicare and Affordable Care Act (ACA) regulations, conducting internal compliance audits and completing carrier audits. The role requires a detail-oriented person with deep knowledge and experience in Medicare and ACA sales and marketing compliance requirements. This is a remote position, so you can work from anywhere in the United States. 

Responsibilities: 

• Monitor and analyze Medicare and ACA sales, marketing and regulatory compliance requirements to ensure compliance with federal/state compliance requirements. 

• Research, interpret, and provide guidance on CMS regulations. 

• Assist in the development, implementation, and maintenance of compliance programs, policies, and procedures that ensure compliance with all government programs relating to CMS. 

• Review and update CMS and OIG policies and procedures to adapt to changing regulatory standards to ensure compliance. 

• Review Medicare Marketing Materials and submit to CMS through HPMS. 

• Oversee agent compliance and conduct regular audits to ensure compliance and identify areas of non-compliance for reporting and corrective action plans. 

• Draft compliance reports, memos, and other communication to the management team regarding regulatory updates and changes. 

• Collaborate with other departments to implement policies and procedures that ensure compliance with CMS and ACA regulations. 

• Work with other FDRs/TPMOs such as downline agent/agency partners, vendors and consultants to ensure they are operating in compliance with CMS regulations. 

• Oversee the annual compliance training program and present compliance updates. 

• Stay up to date with regulatory developments by attending or participating in relevant seminars, continuing education, and professional courses. 

Requirements: 

• Bachelor's degree in Health Policy, Public Health, Business, Marketing or related field or equivalent work experience. 

• 3-5 years of experience in Medicare/ACA, with at least two years in Medicare and ACA sales and marketing compliance. 

• Demonstrated knowledge of HHS/CMS regulations and guidelines for both Medicare and ACA(Marketplace), with a strong focus on the MCMG. 

• Experience conducting carrier compliance audits and assessments. 

• Strong analytical, communication, and problem-solving skills. 

• Ability to work collaboratively and effectively with cross-functional teams. 

• Ability to work remotely with minimal supervision. 

• Proficiency in Microsoft Office Suite and other computer applications. 

• Excellent time-management and prioritization skills. 

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