Compliance Specialist
$60,000–$70,000 year
On-site · Doral, Florida, United States
Job Summary
Compliance Specialist supports Medicare Advantage program and SMAC contract by ensuring regulatory adherence. Responsibilities include monitoring CMS regulatory updates, conducting compliance reviews, analyzing policies/procedures, supporting internal/external audits, developing and delivering compliance training, performing audits across enrollment/claims/UM/case management, identifying trends and risks, and assisting in corrective action plan development to promote a culture of compliance. Requires collaboration across departments and strong analytical, reporting, and communication skills; on-site Monday–Friday in a fast-paced, highly regulated environment.
Required Qualifications
- Bachelor’s or master’s degree in healthcare administration
- Minimum of 2–4 years of experience in healthcare compliance, preferably with Medicare Advantage or Medicaid programs
- Knowledge of CMS regulations, Medicare Advantage requirements, SMAC contracts, and compliance best practices
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