Claims Compliance Manager
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Job Description
Compliance Manager responsible for regulatory compliance in health care claims. Ensuring accurate reporting and client advisement in a remote role.
Responsibilities:
- Own and execute all CMS Section 111 mandatory insurer reporting obligations
- Manage RxDC reporting under the CAA
- Prepare and submit annual PCORI fee filings
- Administer the Gag Clause Prohibition Attestation process
- Develop and maintain Preferred Networks disclosures
- Serve as the internal SME on No Surprises Act compliance
- Monitor and maintain compliance workflows
Requirements:
- 5 years of experience in health care compliance
- Expertise with CMS Section 111 reporting
- Knowledge of ERISA, ACA, HIPAA, and CAA
- Experience drafting or reviewing SPDs and SBCs
- Proficiency with Microsoft Office Suite
- Understanding of self-funded health plans.
Benefits:
- Offers Equity
- Offers Bonus
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