Senior CMS and OPL Specialist

Capital Health Plan is seeking a Senior CMS and OPL Specialist to join our team in Tallahassee, FL, in a full-time position. If you're looking for a rewarding opportunity where your expertise in Medicare compliance, benefit coordination, and regulatory oversight is valued and your work directly supports organizational success, this may be the perfect next step in your career. Apply today!

PAY: This position earns a competitive wage.

BENEFITS:

• Health coverage and dental insurance
• Health and dependent care spending accounts
• Short and long-term disability
• Major disability time off (MDTO)
• Retirement plan
• Life and AD&D insurance
• Voluntary life and AD&D insurance
• Paid time off (PTO)
• Employee assistance program
• SmartDollar

QUALIFICATIONS

• Associate degree or equivalent combination of education and experience
• Related experience in healthcare, insurance, claims, COB, MSP, or compliance functions
• Knowledge of HIPAA requirements, state insurance laws, federal MSP laws, and regulations
• Strong analytical, problem-solving, and organizational skills
• Proficiency with Microsoft Word and Excel
• Ability to interpret regulations, prepare reports, and communicate effectively
• Exceptional attention to detail and relationship-building skills
• Basic math skills
• Ability to occasionally lift and/or move up to 25 lbs

SCHEDULE: This is a full-time position working Monday through Friday from 8 am to 5 pm.

WHAT TO EXPECT AS A SENIOR CMS AND OPL SPECIALIST

In this role, you'll oversee Medicare Secondary Payer and Coordination of Benefits activities, ensure accurate Section 111 reporting, reconcile CMS and Medicare Advantage files, maintain ESRD and COB records, analyze member enrollment and payment data, respond to governmental and recovery demands, investigate insurance liability questions, and collaborate with Finance, Utilization Services, Member Services, and other departments to ensure accuracy, compliance, and optimal benefit coordination.

ABOUT OUR COMPANY

We are a not-for-profit health care organization that has served the panhandle since 1982, delivering high-quality, affordable, and patient-centered care. Our employees are essential to our continued success, and their passion, motivation, and commitment drive our reputation for excellence and member satisfaction.

Whether delivering direct care, supporting patients, or ensuring smooth operations behind the scenes, every team member plays a vital role in fulfilling our mission to improve the health of our communities. We are dedicated to fostering a professional, respectful, and inclusive workplace where employees are valued, supported in their growth, and empowered to make a meaningful impact.

HOW TO APPLY

If you're ready to leverage your CMS, MSP, and COB expertise with an organization that values your knowledge and impact, apply today to be our Senior CMS and OPL Specialist! Our initial application process is quick, easy, and mobile-friendly.

CHP is proud to be an Equal Opportunity Employer and is committed to maintaining a workplace that values professionalism, integrity, and respect. We provide equal employment opportunities to all employees and applicants and do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other legally protected status.