Employment Spot

Job Description

Reports directly to the Director of Claims and Compliance. The main responsibility of this job is to ensure that Company is compliant with all state and federal laws and regulations, within all aspects of company’s Government products and serves as a working leader in the day-to-day claims operations ensuring quality and time-to-process standards. This position is responsible for implementing and monitoring applicable CMS rules and regulation including claims.

This position is responsible for implementing and monitoring applicable CMS rules and regulation including claims. Essential Responsibilities:Establish, implement and administer the Government (Medicare, Medicaid & Florida Healthy Kids) Programs to address specific risk exposures related to applicable state and federal regulations. Create and maintain oversight educational materials and policies and procedures used by Company to manage the Claims and Government for marketing and selling Coventry's Medicare Products. Maintain knowledge of current state and federal compliance laws and regulations relating to healthcare.

Job Requirements

Job Requirements include:*Bachelor's degree or equivalent experience. *Significant (5-7 years) experience in government managed dental care in compliance and dental claims operations. *Must be able to read dental X-Rays. *Extensive knowledge of CMS and product-specific regulations. *Excellent verbal and written communication skills. *Excellent planning, analytical and organizational skills. *Experience with Medicare, CMS/HHS compliance regulations and guidelines. *4-6 years' relevant experience with Compliance Programs, supervisory experience, *preferably in a dental healthcare setting. *Good organizational and communication skills required; Good analytical and interpersonal skills, and the ability to multi task.

Submit resume in word format to [Click Here to Email Your Resumé] with Manager, Government Claims and Compliance in the subject line.