Medicare Compliance Population Health, RN
Crossover Health
full-time
Posted on:
Location Type: Office
Location: Minot • North Dakota • United States
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About the role
- Support the development of Crossover Health’s Medicare Advantage Program.
- Monitor effectiveness of Crossover Health’s Medicare Advantage Compliance Program.
- Manage Crossover’s compliance with Medicare Part C requirements, including risk adjustment and encounter data reporting.
- Monitor and implement applicable CMS updates and Medicare Advantage regulations affecting Crossover Health’s operations.
- Participate in quality improvement programs to ensure the practice is performing efficiently and in accordance with Crossover’s policies.
- Assist with ongoing development and maintaining compliance policies.
- Support protocols for documentation, coding, billing, and patient communication that meet CMS standards.
- Conduct regular compliance training for physicians, clinical staff, administrative personnel and governing board.
- Perform internal audits of clinical documentation, coding, and billing practices.
- Identify compliance risks related to Medicare Advantage participation and implement mitigation strategies.
Requirements
- Graduate from an accredited school of nursing
- Certification in Healthcare Compliance (CHC) or equivalent strongly preferred.
- Minimum 3–5 years of healthcare compliance experience, with direct exposure to Medicare Advantage programs.
- Familiarity with physician practice operations, clinical workflows, and CMS regulations.
- Strong communication, analytical, and leadership skills.
- Minimum 3 years of clinical experience
- Current Registered Nurse license in the state you are practicing
Benefits
- N/A 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score
Applicant Tracking System Keywords
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Hard skills
healthcare complianceMedicare Advantagerisk adjustmentencounter data reportinginternal auditsclinical documentationcodingbillingquality improvementcompliance policies
Soft skills
communicationanalyticalleadership
Certifications
Certified in Healthcare Compliance (CHC)Registered Nurse license