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Regulatory and Reporting Specialist
Location
United States
Posted
4 days ago
Salary
$45.0K - $72.0K / year
Seniority
Mid Level
Job Description
Regulatory and Reporting Specialist
PacificSource Health Plans
• Support all aspects of the Grievance and Appeals (G&A) compliance program for Medicare and Medicaid lines of business • Assume the primary role of interfacing with the Compliance department, Auditors, Vendors and G&A staff for purposes of monitoring and ensuring compliant operations • Interface with the Compliance Department and Fraud, Waste and Abuse teams to evaluate and address fraudulent activities impacting the G&A Department • Conduct internal audits, support external audits, develop policies and procedures, and ensure departmental compliance • Develop auditing and monitoring plans to assess compliance with all State, Federal and internal business rules and regulations • Serve as an inter-departmental liaison for compliance and FWA activities • Inform all business operations and workflow decisions to ensure that programs are compliant with State, Federal and internal business rules and regulations • Be fully informed and ensure compliant processes are in place on all G&A business operations • Conduct frequent monitoring activities of all G&A business operations, publish results and report out to G&A Leadership, Compliance Department, quality committees and other PacificSource leadership teams as applicable • Respond to all compliance related inquiries from internal Compliance Department Staff and external Auditors
Job Requirements
- Minimum of two years of Grievance and Appeals related health insurance experience required
- Strong preference for experience in auditing or compliance related role
- High school diploma or equivalent required; Bachelor's degree preferred
- Strong computer skills
- Excellent verbal and business writing skills
- Excellent public relations skills
- Good understanding of Medical Terminology required
- Requires ability to define and prioritize problems and manage workload without direct supervision
Benefits
- Flexible telecommute policy
- Medical, vision, and dental insurance
- Incentive program
- Paid time off and holidays
- 401(k) plan
- Volunteer opportunities
- Tuition reimbursement and training
- Life insurance
- Options such as a flexible spending account
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