Position Purpose: Ensure compliance with contractual requirements and federal and state government reporting and regulations. Maintain government relations for compliance activities.
- Ensure compliance with contract provisions with various agencies and applicable State and Federal laws
- Serve as compliance resource for day–to-day processes
- Analyze and determine the best course of action for each inquiry/problem
- Act as primary contact for initiating and coordinating compliance projects
- Develop and update plan policies and procedures to ensure compliance with federal and state requirements
- Conduct periodic assessments and audits to ensure compliance with contractual and regulatory requirements and timeliness of submission
- Oversee the day-to-day health plan policies and procedures to ensure federal and state regulatory compliance
Education/Experience: Bachelor’s degree in related field or equivalent experience. 5+ years of compliance or regulatory experience. Advanced experience with Microsoft Office applications. Knowledge of business operations related to managed care preferred.