Compliance & Reporting Manager
- Design and implement programs, policies, and practices to ensure State and Federal program contract compliance, as well as with federal and state legal and regulatory requirements as it relates to Medicare compliance.
- Manage the compliance/reporting staff.
- Oversee the day-to-day health plan policies and procedures to ensure federal and state regulatory compliance.
- Validate state and federal deliverable reports for accuracy and ensure timeliness of submission.
- Review and analysis of health plan deliverables and data to identify trends in performance and opportunities for improvement.
- Ensure timely, accurate and appropriate submission of all State filings related to health plan licensure.
- Act as a resource to staff in all health plan departments related to contract and reporting requirements and regulatory compliance.
- Act as a liaison with State and/or federal agency staff in response to inquiries and requests for information.
- Interact with Corporate compliance staff, and serve as primary health plan liaison with the
- Corporate Special Investigations Unit related to fraud and abuse.
- Conduct oversight audits of health plan procedures and processes to ensure compliance with contractual and regulatory requirements.
- Coordinate with Marketing Manager and Delegation Oversight Manager for applicable activities and initiatives.
- Conduct/manage training programs for all health plan staff as required by contract and applicable regulatory requirements.
- Bachelor's degree in related field.
- 4+ years of compliance/regulatory experience in a health care and/or managed care setting/organization.
- Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.
For more information, please contact our office at 877-782-3334.