Medicare Compliance RN
Crossover Health
full-time
Posted on:
Location Type: Office
Location: Grand Forks • 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.
- Educate staff on fraud, waste, and abuse (FWA) prevention and reporting.
- Perform internal audits of clinical documentation, coding, and billing practices.
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
- Health insurance
- 401(k) matching
- Flexible work hours
- Paid time off
- Crossover Health is committed to Equal Employment Opportunity regardless of race, color, national origin, gender, sexual orientation, age, religion, veteran status, disability, history of disability or perceived disability.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
healthcare complianceMedicare Advantagerisk adjustmentencounter data reportingclinical documentationcodingbillinginternal auditsquality improvementfraud, waste, and abuse prevention
Soft Skills
communicationanalyticalleadership
Certifications
Certified in Healthcare Compliance (CHC)Registered Nurse license