Compliance Manager, El Paso Health

Job Summary

Responsible for managing, planning, organizing, coordinating, and improving the functions associated with accreditation requirements.  Responsible for ensuring compliance with Texas Health and Human Services Commission (HHSC), TDI (Texas Department of Insurance) and Centers for Medicare and Medicaid Services (CMS) regulations and expectations, including creating and monitoring policies and reports (deliverables).  Plays the lead role in collecting information necessary to develop reports that accurately reflect El Paso Health’s current operational status. Manages all Compliance Department duties related to the Medicaid, STAR+PLUS and Medicare lines of business.  Works closely with the Chief Compliance Officer and Compliance Director as well as interfacing with all other operational departments.  Responsible for managing the Compliance Claims Auditor(s) and the Compliance Analyst(s).  Develops and oversees work assignments, inspects work in progress and assures successful completion of work.

Skills

1. Processes advanced business writing skills with a preference for experience in technical, regulatory, or proposal writing preferred.  

2. Knowledge of health care issues, local, State, and Federal regulatory environments.  

3. Knowledge of State and Federal health care laws and applicable privacy and security laws including but not limited to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Patient Protection and Affordable Care Act (2010).  

4. Strong computer skills in Microsoft Office Suite (Access, Power Point, Excel, Word). 

5. Must demonstrate aptitude with project management.

6. Extreme attention to detail, strong analytical, statistical aptitude, planning and organizational skills.  Reports must be current, technically complete and submitted timely. 

7. Strong and effective orally and in writing communication skills.

8. Team building and exemplary interpersonal skills. 

9. Proficient in the principals of analytical assessment and creative problem solving.

10. Understands and utilizes the fundamentals of continuous quality improvement.

11. Ability to work both independently and as a member of the El Paso Health Team.

12. Ability to accept and institute change. 

13. Ability to be a self-starter and follow through on projects with minimal management oversight.  

Work Experience

Three years of management/supervisory experience required.  Strong regulatory and/or accreditation compliance experience required.  Demonstrated experience in analyzing, reporting and interpreting data and information, managing organization-wide projects and performance enhancement efforts, is essential.  State and Federal regulatory research and experience in URAC regulatory compliance highly preferred.  Experience leading organizational wide projects preferred.  Familiarity with State and Federal healthcare laws, along with applicable privacy and security laws, is required. Demonstrated experience in managed care government programs (Medicaid, CHIP, STAR+PLUS, Medicare/Medicare Advantage) is essential.  Experience working with managing regulatory compliance with laws and regulations, writing policies and procedures, and working with quality improvement and/or regulatory compliance is also required.

License/Registration/Certification

Certified Professional Coder (CPC) or Certified Professional Biller (CPB) highly preferred

Education and Training

Bachelor degree in Healthcare, Social Science, or related field required.