Compliance Manager
Core
Overseeing All Payer Claims Database (APCD) reporting and compliance activities to meet state regulatory requirements.
Role type
Compliance Manager
Builds
Regulatory reporting submissions and compliance programs
Domain
Healthcare / Insurance / Pharmacy Benefit Management
Deliverable
client delivery
Required skills
APCD reporting, state regulation interpretation, healthcare claims processing, root-cause analysis, project management, data analysis, system requirements translation
Preferred skills
SAS, SQL, ACL, large dataset analysis, process improvement, regulatory agency liaison
Technologies
SAS, SQL, ACL, Excel, databases
Responsibilities
Manage APCD compliance programs and reporting requirements across multiple states; Lead projects from start to finish including timelines and regulator communications; Interpret state regulations and convert them into business and system requirements; Oversee timely submission of reports, files, and responses to regulators and vendors; Investigate compliance, reporting, and system issues; Write detailed business requirements to address compliance and data issues; Use reporting tools, databases, and data analysis to monitor compliance and improve processes; Identify opportunities to automate and streamline workflows; Train, mentor, and coach team members and business partners; Develop and maintain training materials, policies, procedures, and process documentation; Create management reports and provide recommendations for issue resolution
Seniority
Mid-level, hands-on IC