In support of the Centers for Medicare and Medicaid Services (CMS) Benefits Coordination and Recovery Center (BCRC), the BCRC Policy Specialist will provide technical expertise and guidance to comply with all applicable statutes, regulations and CMS policy. The BCRC Policy Specialist will remain updated on applicable Coordination of Benefits and Medicare Secondary Payer statutes, regulations and policy, and implement all updates into the contractor’s operational environment. The BCRC Policy Specialist will communicate with the Medical Personnel, the Training Specialist, and the Compliance Officer, as appropriate.
As a federal contractor, CNI is a drug-free workplace and adheres to the Federal Controlled Substance Act.
ESSENTIAL REQUIREMENTS
- Must be able to obtain and maintain the required customer clearance for access to systems, facilities, equipment and property.
- Must be able to pass a customer background check for access to facilities, equipment and property. This Homeland Security Investigation requires U.S. Citizenship or Permanent Resident (Green Card) status.
- Ability to multi-task effectively in a dynamic and fast-paced environment.
- Strong analytical skills with the ability to assess issues and develop appropriate resolutions.
- Extensive experience interpreting CMS Coordination of Benefits (COB) and Medicare Secondary Payer (MSP) recovery policies.
- In-depth knowledge of CMS Internet-Only Manual (IOM) guidelines for MSP Recovery, as well as other Medicare laws and regulations, including HIPAA.
- Operational understanding of Medicare policies, procedures, and MSP-related systems such as ReMAS, CWF/HIMR, ECRS, HIGLAS, BCRS, and image repositories.
- Proficient in Microsoft Office Suite, including Word, Excel, PowerPoint, and Access.
- Exceptional attention to detail with strong organizational, analytical, problem‑solving, and critical‑thinking abilities.
- Excellent written and verbal communication skills, with the ability to deliver clear guidance on policy updates to internal teams and external stakeholders.
- Ability to communicate complex information concisely to individuals with varying levels of expertise.
- Demonstrated skill in fostering teamwork and coordinating efforts to achieve organizational goals.
- Proven ability to constructively resolve conflicts, grievances, and disagreements.
- Experience developing, documenting, and implementing approved procedural changes.
- Strong project and time-management skills, with the ability to manage multiple priorities and meet deadlines.
- Ability to handle confidential and sensitive information with discretion.
- Capable of working independently as well as collaboratively within a team.
- Ability to travel and work between the hours of 6:00 a.m. and 7:00 p.m. as needed.
Essential duties and responsibilities include the following. Other duties may be assigned.
- Reviews and implements policy guidelines related to Coordination of Benefits and MSP recovery work performed under the BCRC contract.
- Reviews and provides feedback on all Standard Operating Procedure and BCRC letter changes.
- Participates in major functional user groups.
- Provides technical expertise and guidance to ensure compliance with all applicable statutes, regulations and Centers for Medicare and Medicaid Services’ Policies.
- Works closely with the Training Staff, SOP Specialists, and the Compliance Officer to ensure organization-wide procedural uniformity.
- Collaborating with cross-functional teams such as compliance officers and auditors to ensure adherence to regulatory guidelines.
- Works with the Centers for Medicare and Medicaid Services regarding policy issues and questions; provides input regarding Technical Direction, Letters, Joint Operating Agreements (JOAs) and CMS Change Requests.
- Identifies trends and makes recommendations for process improvements.
- Pursues continued process improvements while ensuring compliance with the BCRC Statement of Work.
- Maintains confidentiality and upholds standards for privacy and data integrity and security.
- Responsible for adherence to qualitative and quantitative standards as established to meet contractual obligations and changing business requirements.
- Will report any unsafe conditions and/or practices to the appropriate supervisor and human resources. Will immediately correct any unsafe conditions to the best of own ability.
EDUCATION / EXPERIENCE
Bachelor’s degree and a minimum of 8+ years’ relevant experience with MSP Recovery, or equivalent combination of education/experience.
PHYSICAL DEMANDS
Work is primarily performed in an office environment. Regularly required to sit. Regularly required use hands to finger, handle, or feel, reach with hands and arms to handle objects and operate tools, computer, and/or controls. Required to speak and hear. Occasionally required to stand, walk and stoop, kneel, crouch, or crawl. Must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, depth perception, and ability to adjust focus. Exposed to general office noise with computers printers and light traffic.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this job.
The estimated pay range for this role is $90,000 to $100,000, with the final offer contingent on location, skillset, and experience.
CNI offers a comprehensive benefits package that includes:
Medical
Dental
Vision
401(k)
Family Planning/Fertility Assistance
STD/LTD/Basic Life/AD&D
Legal-Aid Program
Employee Assistance Program (EAP)
Paid Time Off (PTO) – (11) Federal Holidays
Training and Development Opportunities
Your application submission will be considered for all potential employment opportunities with Chickasaw Nation Industries (CNI).
