About the Position

We're seeking a MEDICARE COMPLIANCE PROGRAM LEAD to ensure adherence to CMS regulations and Medicare guidelines, working remotely within the USA.

Responsibilities

Administer the Medicare compliance program, ensuring adherence to CMS regulations, Medicare guidelines, and DMEPOS standards
Audit Medicare-related operational processes, including intake documentation, qualification, re-certification, and billing readiness
Establish and monitor internal controls and auditing systems to identify compliance risks and operational gaps
Serve as the primary compliance liaison across Intake, RCM, Customer Care, and Operations to improve Medicare workflows and resolve compliance-related issues
Conduct routine audits of patient documentation, billing readiness, and reimbursement processes to ensure regulatory compliance
Interpret new and revised Medicare regulations and implement process updates to maintain compliance
Develop and maintain compliance policies, procedures, and documentation standards
Lead training initiatives and provide ongoing guidance to staff on Medicare documentation requirements, eligibility criteria, and billing standards
Provide guidance related to audits, denials, and compliance concerns
Prepare and present compliance reports, audit findings, and risk assessments to leadership
Identify opportunities for operational improvement and support strategic initiatives related to Medicare growth and compliance scalability
Provide guidance, onboarding support, and subject matter expertise to new team members as the department expands
Perform other duties as assigned

Bachelor’s degree preferred or equivalent combination of education and experience
Minimum 5 years of healthcare compliance experience, with strong Medicare, CMS, or DMEPOS experience required
Minimum 2 years of experience leading cross-functional compliance initiatives and operational workflows preferred
Strong knowledge of Medicare intake, billing, documentation requirements, and reimbursement processes
Demonstrated ability to interpret complex healthcare regulations and implement operationally effective solutions
Experience with internal auditing, compliance investigations, and corrective action planning
Advanced proficiency in Microsoft Office (Word, Excel, Outlook) and Adobe
Strong analytical, organizational, and problem-solving skills
Ability to manage multiple priorities in a fast-paced environment
Must be available to work evenings, weekends, and holidays if needed

Stance Health Solutions, Inc is committed to providing top-notch healthcare services and ensuring compliance with all regulatory standards.