SG Homecare

• Administer the Medicare compliance program, ensuring adherence to CMS regulations, Medicare guidelines, and DMEPOS standards • Audit Medicare-related operational processes, including intake documentation, qualification, re-certification, and billing readiness • Establish and monitor internal controls and auditing systems to identify compliance risks and operational gaps • Serve as the primary compliance liaison across Intake, RCM, Customer Care, and Operations to improve Medicare workflows and resolve compliance-related issues. • Conduct routine audits of patient documentation, billing readiness, and reimbursement processes to ensure regulatory compliance • Interpret new and revised Medicare regulations and implement process updates to maintain compliance • Develop and maintain compliance policies, procedures, and documentation standards • Lead training initiatives and provide ongoing guidance to staff on Medicare documentation requirements, eligibility criteria, and billing standards • Provide guidance related to audits, denials, and compliance concerns • Prepare and present compliance reports, audit findings, and risk assessments to leadership • Identify opportunities for operational improvement and support strategic initiatives related to Medicare growth and compliance scalability • Provide guidance, onboarding support, and subject matter expertise to new team members as the department expands • Perform other duties as assigned

• Supervise, coach, and develop Medicare Specialists and related support staff • Conduct regular one-on-one meetings, performance evaluations, and productivity reviews • Monitor staffing levels and distribute workloads to ensure timely and efficient order processing • Create and implement training plans focused on Medicare regulations and operational best practices • Oversee the review and processing of Medicare orders to ensure accuracy • Ensure all required documentation is obtained prior to order fulfillment • Review and resolve complex Medicare eligibility and documentation issues • Monitor order queues and workflow backlogs to ensure service level expectations • Maintain compliance with Medicare regulations and company policies • Conduct quality audits of completed orders and team workflows • Analyze trends related to denials and recommend corrective actions • Collaborate with cross-functional teams to support efficient order processing and reimbursement success