The Compliance Specialist ensures adherence to health plan regulations, including Texas Medicaid, TDI, OIG, CMS, and HIPAA. They manage regulatory reporting, interpret regulatory changes, and coordinate delivery of compliance requirements. The role involves building strong relationships with regulatory agencies and internal teams to maintain transparency and accountability.
POSITION SUMMARY/RESPONSIBILITIES
The Compliance & Regulatory Specialist is responsible for assisting in the oversight and execution of compliance in the health plan’s operational areas, including delegated operational activities and regulatory reporting. The candidate 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 coordinate and facilitate the execution of the company’s regulatory deliverables. The Compliance & Regulatory Specialist will assist with the interpretation of and/or execution of changes in regulations and guidelines, including HIPAA. This position will need to build key relationships with regulatory agencies and internally 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 desired but will accept experience in lieu of education. Proficiency in Microsoft Office applications.
Compliance, Regulatory Reporting, Texas Medicaid, HIPAA, Health Plan, CMS, OIG Compliance, Regulatory Guidelines, Healthcare Administration, Risk Management
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