PacificSource Health Plans logo
PacificSource Health Plans

Putting members first since 1933.

Regulatory and Reporting Specialist

ComplianceComplianceFull TimeRemoteMid LevelTeam 1,001-5,000Since 1933H1B No SponsorCompany SiteLinkedIn

Location

Tennessee

Posted

4 days ago

Salary

$45.0K - $72.0K / year

Seniority

Mid Level

High School2 yrs expEnglish

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 • In partnership with Compliance staff and G&A leadership, 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 an internal business rules and regulations • Be fully informed and ensure compliant processes are in place on all G&A business operations • Maintain a current working knowledge of all applicable Medicare, and Medicaid rules and regulations • 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 in a timely, professional and accurate manner

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

Related Categories

Related Job Pages

More Compliance Jobs

Controlling Profesional

Siemens

Siemens Energy, part of Siemens, aims to be a global leader in the energy technology field, whose mission is to reduce the environmental impacts of the energy f

Compliance4 days ago

Title: Professional Controlling Location: Hybrid (Remote/Office) Mexico (Any Siemens location in Mexico) Job Type: Full-time Job Description We are Siemens. A team of over 5,000 phenomenal minds who are shaping the future and you can be a part of it! We have factories all over Mexico, full of hardworking people who help us defy today and work toward a brighter tomorrow. If we all thought the same thing, we would never think of anything new! That's why we recruit great minds from all walks of life. Responsibilities - Monitoring and analysis of results of operational areas (PMs/CPMs, C&C, ENG PA, ENG MV, CC) - Update, monitoring and analysis of the monthly P&L Sales (BI and Excel) - Preparation of annual planning and updating of quotas (C&C, ENG PA, ENG MV, CC) - Productivity control assigned operational areas - Reporting and recording of HORING transfer of costs to Orders in Development - Cost-center controlling internal cost reporting and transfers, JETS elaboration - Control of services other countries (PATAC), personal collections USA - Internal development orders and models - Charges for Services with OC or Referral with SLA (Non Revenue Order) - CAM when there is horing of C&C, CC, ENG PA Requirements - Minimum 3 years of experience in controlling for Field Service areas or teams - Fluent English - Good command of Excel and Power BI - Experience in handling data - Experience with Labor Hour Service Reporting - Experience with Service Quota Calculation Equal Employment Opportunity Statement Siemens is an equal opportunity and affirmative action employer that encourages diversity in the workplace. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, national origin, citizenship status, ancestry, sex, age, physical or mental disability, marital status, family responsibilities, pregnancy, genetic information, sexual orientation, gender expression, gender identity, transgender, sex stereotyping, protected veteran or military status, and other categories protected by federal law, state or local law.

Mexico
Full TimeRemoteTeam 501-1,000Since 2015H1B No Sponsor

• Develop, document, and maintain policies, procedures, and process narratives supporting government contracting compliance • Ensure alignment with DFARS business system requirements (e.g., Accounting, Purchasing, Estimating, MMAS) • Evaluate internal processes and controls for compliance with FAR, DFARS, and other regulatory standards • Support DCAA/DCMA audits and business system reviews, including documentation, walkthroughs, and corrective actions • Conduct internal compliance assessments and gap analyses; track remediation efforts • Partner with stakeholders across Finance, Contracts, Supply Chain, and Program Management to ensure consistent process execution • Lead or support process improvement initiatives to enhance efficiency while maintaining compliance • Maintain documentation repositories and ensure version control and audit readiness

District Of Columbia + 2 moreAll locations: District Of Columbia | Texas | Washington
$88K - $130K / year
Solenis logo

Junior Regulatory Affairs Analyst

Solenis

Building a safer & healthier world through sustainable innovation.

Compliance4 days ago
Full TimeRemoteTeam 10,001+H1B Sponsor

• Respond to clients' regulatory requests and complete approval forms and regulatory questionnaires • Prepare, organize, and provide regulatory and technical information about products • Support the commercial team with regional and global regulatory inquiries • Monitor and track clients' regulatory requests • Maintain up-to-date regulatory records and manage information in databases and corporate systems • Update and control regulatory data in internal systems, including SAP • Assist in preparing and issuing customer support documentation • Ensure the quality, integrity, and compliance of regulatory information provided • Collaborate with multidisciplinary teams in a global environment

Brazil
Full TimeRemoteTeam 10,001+H1B Sponsor

• Lead and support HIPAA security compliance workstreams across products, platforms, systems, and engineering teams. • Turn legal requirements into actionable technical and operational control requirements. • Perform HIPAA readiness assessments, gap analyses, risk assessments, and control design/effectiveness reviews. • Build and maintain control mappings across HIPAA, HITRUST, SOC 2, ISO 27001, NIST 800-53, and DoorDash security standards. • Partner with Engineering and Security Engineering to implement scalable controls. • Maintain HIPAA security program documentation including policies, standards, and procedures. • Support internal and external audits and compliance evidence collection. • Partner with Legal and Security Operations on incidents involving PHI/ePHI. • Mature GRC tooling and continuous control monitoring • Provide practical guidance to stakeholders regarding HIPAA requirements. • Monitor regulatory changes related to HIPAA and healthcare security.

California
$132.6K - $195K / year