This position is responsible for providing overall managerial direction and leadership for healthcare reporting and compliance with federal, state and industry healthcare regulations and standards. Also responsible for developing effective compliance solutions and guiding clients in navigating through the rapidly evolving areas of benefits compliance.
Provides healthcare reform and other compliance regulations subject matter expertise across the business units to support compliance management and self-monitoring in the business, using training, tools and technology.
Evaluates the impact of new and changing laws and regulations on current business processes and manages projects to incorporate changes and deploy to clients and employees. Applicable regulations include, but are not limited to, ACA (Affordable Care Act), ACA IRS Reporting, Medicare & CHIP programs, employer-required state reporting, non-discrimination testing and any other regulatory directives.
Leads annual Applicable Large Employer determination and Variable Hour Employee eligibility determination effort as required under the provisions of the Affordable Care Act.
Produces Forms 1095-C employee statements and files Forms 1094-C and 1095-C with the IRS on behalf of the corporation.
Manages healthcare reform vendor relationships, facilitating contract negotiations and product renewals.
Conducts quarterly healthcare compliance audits and initiatives, including guidelines and standardized processes for communication, testing, training, and documentation.
Manages the staff responsible for reporting and compliance, providing guidance, direction and leadership to the team. Team responsibilities include tracking eligibility for all employees, consulting with clients, monitoring and adhering to state reporting requirements, assessing inbound eligibility verifications, monitoring state-specific waiting periods, and monitoring seasonal classification utilization, and conducting compliance audits as needed.
Determines group workload, assesses staff needs; interviews, hires, and trains employees; plans, assigns, and directs work; conducts performance appraisals, addresses complaints and resolves problems.
Maintains working relationships with Legal, sales support and service providers as needed to support compliance functions.
