Join to apply for the Medicare Compliance Specialist role at FirstEnroll
17 hours ago Be among the first 25 applicants
Join to apply for the Medicare Compliance Specialist role at FirstEnroll
Medicare Compliance SpecialistPosition Summary
This position is part of Heathos, an integrated insurance services ecosystem comprising FirstEnroll, AdminOne, and SonicMarketing. The Medicare Compliance Specialist will focus on compliance initiatives within SonicMarketing, a National Marketing Organization (NMO) that supports licensed agents and facilitates direct carrier partnerships. While this role primarily supports SonicMarketings operations, the paying entity is FirstEnroll, Heathoss Third-Party Administrator specializing in billing and post-enrollment services. This structure ensures cross-functional collaboration and alignment with unified compliance standards across the Heathos platform.
Medicare Compliance SpecialistPosition Summary
This position is part of Heathos, an integrated insurance services ecosystem comprising FirstEnroll, AdminOne, and SonicMarketing. The Medicare Compliance Specialist will focus on compliance initiatives within SonicMarketing, a National Marketing Organization (NMO) that supports licensed agents and facilitates direct carrier partnerships. While this role primarily supports SonicMarketings operations, the paying entity is FirstEnroll, Heathoss Third-Party Administrator specializing in billing and post-enrollment services. This structure ensures cross-functional collaboration and alignment with unified compliance standards across the Heathos platform.
The Medicare Compliance Specialist is responsible for ensuring adherence to Centers for Medicare & Medicaid Services (CMS) regulations governing Medicare Advantage (MA), Part D, and related senior market programs. This role supports organizational compliance by managing complaint resolution, internal audits, and CMS correspondence, while also contributing to regulatory readiness, quality monitoring, and agent contracting operations. The ideal candidate will have a strong understanding of Medicare regulatory requirements, a compliance- and service-oriented mindset, and the ability to collaborate across departments to support continuous improvement.
Key Responsibilities: 1. Medicare Compliance Monitoring & Regulatory Oversight
- Track, monitor, and respond to Medicare-related complaints using internal tracking systems and CTM (as applicable).
- Maintain complete and timely records of compliance activities, regulatory submissions, and supporting documentation.
- Coordinate with internal and external stakeholders to gather and validate compliance-related data.
- Prepare and file accurate responses to CMS inquiries, data requests, and regulatory submissions.
- Monitor and disseminate CMS policy updates (e.g., HPMS memos, MCMG) and assist in interpreting implications for the business.
- Conduct comprehensive regulatory reviews and assist business owners with understanding new or revised CMS requirements.
- Coordinate the submission and documentation of regulatory filings and marketing materials as required.
- Coordinate the filing of regulatory forms, reports, marketing materials, and other submissions; assist other departments in understanding and complying with regulatory requirements, including data entry and documentation.
- Provide regulatory support and guidance to business owners as new regulations emerge; collaborate with business units to ensure policies and processes are implemented in alignment with CMS regulatory and contractual requirements.
- Perform comprehensive and complex regulatory analyses, including the review, summarization, and distribution of key updates and regulatory changes.
- Conduct internal audits of CMS-regulated functions including marketing, enrollment, telephonic interactions, and third-party websites.
- Perform ad hoc investigations related to compliance risks, potential violations, or consumer complaints.
- Identify, escalate, and help resolve compliance issues and operational irregularities.
- Develop and monitor corrective action plans (CAPs) based on audit findings or complaint trends.
- Partner with account management and leadership to communicate trends, provide training recommendations, and implement improvement strategies.
- Conduct routine audits of various sales activities, including marketing events, third-party websites, and telephonic recordings, to ensure compliance with CMS standards.
- Evaluate calls, emails, and chat transcripts using a standardized quality and compliance scorecard.
- Track and report quality trends, identifying areas for improvement.
- Partner with department leaders to align training and quality initiatives with compliance goals.
- Create and maintain process documentation for quality monitoring activities.
- Respond to agent contracting inquiries via phone, email, or chat in a timely and professional manner.
- Educate agents on products, services, compliance policies, and contracting procedures.
- Troubleshoot technical issues and provide assistance through to resolution.
- Maintain open communication with agents to ensure they are informed and supported.
- Document and maintain SOPs for contracting processes and regulatory expectations.
Education
- High school diploma or equivalent required; bachelors degree in healthcare administration, public policy, or a related field preferred.
- Minimum 2 years of experience in Medicare compliance or related roles within managed care, health plans, TPAs, or NMOs.
- Experience handling CMS-related complaints, data reporting, and regulatory submissions strongly preferred.
- Experience in customer service, agent support, or CRM systems also preferred.
- Strong understanding of CMS regulations and ability to interpret federal guidance.
- Exceptional written and verbal communication skills, including experience drafting formal regulatory responses.
- High level of attention to detail, organization, and time management.
- Ability to manage multiple projects, prioritize effectively, and work independently or collaboratively.
- Proficiency in Microsoft Excel, SharePoint, compliance tracking tools, and CRM platforms.
Seniority level
Seniority level
Entry level
Employment type
Employment type
Full-time
Job function
Job function
Finance and Sales-
Industries
Business Consulting and Services
Referrals increase your chances of interviewing at FirstEnroll by 2x
Get notified about new Compliance Specialist jobs in Alpharetta, GA .
Atlanta, GA $77,600.00-$97,000.00 1 week ago
Atlanta, GA $120,000.00-$150,000.00 3 weeks ago
Compliance Investigations and Regulatory Manager
Atlanta, GA $100,000.00-$115,000.00 1 week ago
Regulatory Affairs and Compliance Manager
Regional Starts and Compliance Specialist
Atlanta, GA $125,000.00-$165,000.00 2 weeks ago
Atlanta Metropolitan Area $20.00-$25.00 5 days ago
Atlanta, GA $130,000.00-$140,000.00 6 days ago
Associate Regulatory Affairs Manager (Onsite)
Atlanta, GA $130,170.00-$153,141.00 1 day ago
Were unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr