Compliance Manager
: Job Details :

POSITION SUMMARY/RESPONSIBILITIES The Senior Compliance Manager, Medicare, Marketplace, and Commercial is responsible for administration, integration, and oversight of compliance in the health plan's operational areas, including delegated operational activities and regulatory reporting. This position reports to the Director, Compliance & Risk Management. The position must be knowledgeable regarding current Texas Department of Insurance (TDI) regulations and the Centers for Medicare and Medicaid Service Regulations (CMS). As a component of the oversight and coordination for dual eligible Medicare membership, the Senior Compliance Manager is familiar with Texas Medicaid regulations, the Texas Department of Health and Human Services Commission (HHSC) contract and regulations, and Office of Inspector General (OIG) Compliance Plan. This position is the Compliance lead for the Medicare, Marketplace and Commercial lines of business. This position coordinates and facilitates the execution of the organization's regulatory deliverables for the Medicare, Marketplace, and Commercial lines of business. The Senior Compliance Manager assists with the interpretation of and/or execution of changes in regulations and guidelines, including HIPAA. This position builds key relationships with regulatory agencies, to include TDI, CMS and HHSC, and works internally to facilitate improved interaction, transparency and accountability with the designated department leaders and staff responsible for Medicare, Marketplace and Commercial lines of business. EDUCATION/EXPERIENCE A bachelor's degree in business administration, public administration, health care administration or a related field is required OR a minimum of five years in the managed care industry may be substituted for college education. Must have proficiency in Microsoft Office applications.