Policy Specialist (Medicare/Medicaid)

Location: Remote within the United States; U.S. Citizenship or Permanent Resident (Green Card) status required

Salary: $90,000–$100,000 per year

Company

hirify.global is a holding company supporting federal government and commercial enterprises through business services, health, infrastructure and engineering, mission optimization, technology, and transportation subsidiaries.

What you will do

• Review and implement Coordination of Benefits and Medicare Secondary Payer policy guidelines for the CMS Benefits Coordination and Recovery Center contract.
• Interpret applicable statutes, regulations, CMS policies, HIPAA requirements, and Internet-Only Manual guidance.
• Review and provide feedback on Standard Operating Procedures, BCRC letters, Technical Direction, Joint Operating Agreements, and CMS Change Requests.
• Provide technical guidance to CMS, internal teams, external stakeholders, training staff, SOP specialists, compliance officers, and auditors.
• Identify trends, recommend process improvements, and implement approved procedural changes.
• Maintain confidentiality, privacy, data integrity, security, and compliance with contractual quality standards.

Requirements

• Bachelor’s degree and at least 8 years of relevant experience with Medicare Secondary Payer recovery, or an equivalent combination of education and experience.
• Extensive experience interpreting CMS Coordination of Benefits and Medicare Secondary Payer recovery policies.
• In-depth knowledge of CMS Internet-Only Manual guidelines, Medicare laws and regulations, and HIPAA.
• Operational knowledge of ReMAS, CWF/HIMR, ECRS, HIGLAS, BCRS, image repositories, and Microsoft Office.
• Strong analytical, problem-solving, communication, organizational, project-management, and conflict-resolution skills.
• Must obtain and maintain the required customer clearance and pass a background check; the Homeland Security Investigation requires U.S. Citizenship or Permanent Resident (Green Card) status.

Culture & Benefits

• Full-time employment with medical, dental, and vision coverage.
• 401(k) with immediate vesting, life insurance, short- and long-term disability coverage, and an employee assistance program.
• Paid time off, 11 federal holidays, family planning and fertility assistance, and legal-aid assistance.
• Professional development, training, and development opportunities.
• Ability to travel and work between 6:00 a.m. and 7:00 p.m. as needed.