Oversee All Payer Claims Database (APCD) states
Ensure organizational adherence to all regulatory requirements
Manage high risk areas
Handle vendor and regulator requests regarding laws, bulletins, and other requests
Deliver all file types and responses to inquiries
Set timelines for new APCDs
Write requirements for all systems and affiliates
Mentor and train within the team and across organizational lines
Create reports for management
Identify issues and communicate findings and potential resolutions with management and IT teams
Run, review, and set up projects end to end including timelines and extensions
Translate regulations into business requirements
Use automated and non-automated tools for project management
Research and investigate issues identified internally and by customers
Identify possible system issues and assist with corrections
Write complex business requirements based on findings
Utilize knowledge of data sources, systems, and products to influence process changes
Build strong teams within the APCD team and across other teams

Requirements

Minimum 5 years of experience in Compliance/Legal in healthcare, insurance or financial services setting
Minimum 5 years of knowledge of all types of health care products including HMO, PPO, Medicare Advantage and Medicare Part D
Minimum 2 years of knowledge of all types of pharmacy products including specialty drug, Medicare Part D and understanding of PBM operations
Ability to travel up to 10% (including plane)
4-6 years of data interpretation and analysis experience (preferred)
5-8 years of experience in technology – SAS, SQL, ACL, Excel, Other database tools, Microsoft Office Suite (preferred)
Extensive experience with databases as well interpretation and manipulation of related data (preferred)
8+ years of healthcare background – ability to review and interpret State/Federal regulations/legislation and create business requirements (preferred)
3-5 years of experience in project management and process redesign (preferred)
3+ years Compliance related functions including contact with regulatory bodies (preferred)

Benefits

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
Wellness screenings
Tobacco cessation and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access
Many other benefits depending on eligibility

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

data interpretationdata analysisproject managementprocess redesignbusiness requirements writingregulatory compliancevendor managementissue identificationsystem issue resolutionhealthcare product knowledge

Soft Skills

mentoringtrainingcommunicationteam buildingproblem solvingorganizational skillsleadership