POSITION SUMMARY/RESPONSIBILITIES
The Senior Compliance & Regulatory Specialist is responsible for facilitating and leading department Specialists in the oversight and execution of compliance activities in the health plan's operational areas, including delegated operational activities and regulatory reporting. The Senior Specialist must be familiar with current Texas Medicaid regulations, the Texas Department of Health and Human Services, Texas Department of Insurance (TDI) regulations, the Office of Inspector General (OIG) Compliance Plan, the Centers for Medicare and Medicaid Services (CMS) and should also be familiar with health plan documents such as Summaries of Benefits and Coverage, Schedules of Benefits and Certificates of Coverage. This position will lead, coordinate and facilitate the execution of the health plan's regulatory deliverables. The Senior Specialist will assist with the interpretation of and/or execution of changes in regulations and guidelines, including HIPAA. This position will build key relationships with regulatory agencies and internal stakeholders to facilitate improved interaction, transparency and accountability.
EDUCATION/EXPERIENCE
A bachelor's degree in business administration, public administration, health care administration or a related field is required. Experience in lieu of education may be considered based on years of experience in health care or managed care. Proficiency in Microsoft Office applications is required. Supervisory experience is preferred but not required.