Helix Healthcare Consultant

Job Overview:

• We are seeking individuals with expertise in Medicare Advantage regulatory compliance, particularly those who are experienced in managing high-stakes CMS audits, compliance program administration, risk assessments, monitoring and auditing, corrective actions, policy formulation, FDR oversight, and pertinent Medicare regulations.

Primary Duties:

• Proficient in regulatory compliance within the US healthcare sector, with a strong focus on Medicare Advantage programs
• Involved in CMS audits related to Medicare Advantage
• Experience with HEDIS and STAR ratings
• Familiarity with Medicare regulations, FDR oversight, audit requirements, and HIPAA compliance
• Comprehensive knowledge of healthcare payer operations
• Experience in managing compliance programs, including conducting risk assessments, policy development, training, monitoring, reporting, and handling audits and investigations

Additional Duties:

• Experience in creating HIPAA-compliant applications and operational workflows
• Proficient in cloud technology and implementing controls for BPaaS environments
• Exceptional communication, presentation, and interpersonal skills
• Able to influence cross-functional teams without direct oversight
• Strong analytical abilities and risk-based decision-making skills

Preferred Qualifications:

Technology->Java->Core Java