Compliance Specialist
Posted on: 10 Jan 2021
Austin, TX
Job Description
Position Purpose:
Ensure compliance with contractual requirements and federal and state government reporting and regulations. Maintain government relations for compliance activities.
* Ensure compliance with contract provisions with various agencies and applicable State and Federal laws
* Serve as compliance resource for dayto-day processes
* Analyze and determine the best course of action for each inquiry/problem
* Act as primary contact for initiating and coordinating compliance projects
* Develop and update plan policies and procedures to ensure compliance with federal and state requirements
* Conduct periodic assessments and audits to ensure compliance with contractual and regulatory requirements and timeliness of submission
* Oversee the day-to-day health plan policies and procedures to ensure federal and state regulatory compliance
Education/Experience:
Bachelors degree in related field or equivalent experience.
5+ years of compliance or regulatory experience.
Advanced experience with Microsoft Office applications.
Knowledge of business operations related to managed care preferred.
RN License preferred
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
WellCare
Tampa, FL
WellCare Health Plans, Inc. provides government-sponsored managed care services. The company operates in three segments: Medicaid Health Plans, Medicare Health Plans, and Medicare Prescription Drug Plans (PDPs). The Medicaid Health Plans segment offers plans for beneficiaries of temporary assistance for needy families, supplemental security income, and aged blind and disabled residents; and other state-based programs, such as children's health insurance programs and long-term services and supports programs for qualifying families who are not eligible for Medicaid.
The Medicare Health Plans segment provides Medicare, a federal program that provides eligible persons aged 65 and over, as well as some disabled persons with a range of hospital, medical, and prescription drug benefits; Medicare Advantage, a Medicare’s managed care alternative to the original Medicare program, which offers individuals standard Medicare benefits directly through Centers for Medicare & Medicaid Services; and coordinated care plans that are administered through health maintenance organizations and require members to seek health care services and select a primary care physician from a network of health care providers.
The Medicare PDPs segment provides Medicare part D PDP plans to Medicare-eligible beneficiaries. Its PDP plans offer national in-network prescription drug coverage, including a preferred pharmacy network. As of December 31, 2018, the company served approximately 5.5 million members in the United States. WellCare Health Plans, Inc. was founded in 1985 and is headquartered in Tampa, Florida.
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IndustryHealthcare
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No. of Employees12, 000
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Website
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Jobs Posted917
