Senior Compliance Administrator, Medicare Claims – Payment Integrity

Role Overview

• Serves as an individual contributor and subject matter expert responsible for supporting the day-to-day execution of the Medicare Compliance Advisory program in alignment with CMS requirements and applicable federal and state regulations
• Provides trusted advisory support to business and compliance leadership by providing regulatory guidance, conducting research and analysis, tracking issues, contributing to audit readiness and supporting compliance workplan activities
• Partners closely with the Sr. Manager, Medicare Compliance Advisory
• Execute the Medicare Compliance Program in alignment with CMS and applicable federal and state regulations, ensuring prevention, detection, and correction of noncompliance and FWA
• Execute assignments, ensuring timely, accurate, and well-documented completion of deliverables
• Serve as a compliance advisor and subject matter resource for Medicare programs by interpreting CMS regulations and guidance and translating requirements into clear, actionable business input; as well as advising leadership on compliance impact and implementation needs
• Support intake, tracking, and resolution of compliance issues, including documenting findings, assessing risk, and recommending corrective actions
• Contribute to monitoring and oversight activities by identifying regulatory risks and trends and supporting resolution of identified issues
• Prepare draft responses and supporting materials for regulatory inquiries, audits, data requests, and internal compliance reviews
• Maintain accurate and complete documentation of compliance activities, including issue logs, regulatory references, self-disclosures and supporting evidence
• Collaborate with cross-functional business partners to clarify regulatory requirements and support the implementation of compliant processes
• Escalate compliance risks, gaps, or delays in a timely manner to support effective risk management and decision-making
• Contribute to audit readiness by supporting documentation, process validation, and issue resolution activities
• Identify process improvement opportunities and support initiatives to enhance compliance controls, standardization, and operational efficiency
• Support compliance training and education initiatives, ensuring awareness of Medicare regulatory program requirements, standards of conduct, and reporting obligations.

Requirements

• Bachelor’s degree in a related field (e.g., healthcare administration, public health, policy) or equivalent experience required
• 5+ years Compliance, regulatory, operations, or risk management within a regulated industry (e.g., healthcare, managed care, insurance, or public sector)
• Demonstrated experience interpreting and applying complex regulatory frameworks and compliance program requirements within a regulated environment into clear, actionable guidance for business stakeholders required
• Experience leading cross-functional initiatives or large-scale compliance efforts, required
• Experience conducting risk assessments, analyzing data, and applying structured problem-solving approaches to identify compliance risks and recommend mitigation strategies required
• Experience effectively communicating with and managing relationships across stakeholders, including presenting complex compliance concepts to diverse audiences required
• Demonstrated experience influencing cross-functional partners and driving outcomes in a matrixed environment without direct authority required
• Experience supporting managed care, Medicare Advantage/Part D, or Dual Eligible (DSNP) programs.
• Foundational knowledge of Medicare regulations, including CMS guidance and compliance expectations (e.g., Parts C & D)

Benefits

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• flexible approach to work with remote, hybrid, field or office work schedules