ACA Compliance Program Manager (Hybrid)

Parkland Health; Dallas (TX); Hybrid; USD 110,000 - 150,000; Full time

Job summary

Parkland Community Health Plan is seeking a Program Manager, ACA to ensure compliance with federal and state regulations across ACA products and plans. You will develop policies, lead audits, and oversee training to ensure compliance with CMS, TDI, and internal standards.

The role requires 5+ years in managed care compliance, strong regulatory knowledge, and the ability to educate diverse teams on ACA requirements. Hybrid work schedule with days 8am-4pm.

Qualifications

• Bachelor’s degree in business, public health, health policy, health care administration, legal studies or a related field.
• Master’s degree in business, public health, health policy, health care administration, legal studies and/or another advanced degree preferred.
• 5+ years of directly related experience in managed care operations, health care compliance, and related legislative and regulatory research or equivalent experience.
• Experience in administration, management and oversight of ACA products and plans, focusing on contract compliance, audits, corrective action plans and risk management.
• Experience with developing, implementing or administering compliance education and training for ACA requirements.
• Knowledge of federal and state government regulations, CMS and TDI reporting requirements for ACA products and plans.

Responsibilities

• Maintain and track federal and state laws, regulations, and sub regulatory guidance affecting the ACA product line and contract documentation.
• Provide compliance oversight of sales, marketing, agent/broker activities, quality, provider and network management, clinical operations, utilization management, claims, enrollment and eligibility, and member services to meet ACA, CMS, and TDI requirements.
• Manage annual QHP certification, recertification, and renewal cycle, including CMS plan data submissions and essential health benefits reviews.
• Coordinate federal and state regulatory reporting and data submissions for ACA, including MLR reporting and risk adjustment.
• Develop policies and engage stakeholders in annual review of all policies for ACA compliance.
• Provide ACA compliance training to employees and delegated entities; mentor department staff.
• Conduct compliance audits and monitoring of ACA operations; prepare for CMS audits and HHS-RADV reviews.
• Identify risks and trends; report findings to relevant departments.

Skills

Analytical thinking

Regulatory knowledge

Communication

Stakeholder management

Attention to detail

Training delivery

Audit management

MS Office

ACA compliance

Education

Bachelor’s degree

Master’s degree

Tools

MS Office

Job description

Parkland Community Health Plan is seeking a Program Manager, ACA to ensure compliance with federal and state regulations across ACA products and plans. You will develop policies, lead audits, and oversee training to ensure compliance with CMS, TDI, and internal standards.

The role requires 5+ years in managed care compliance, strong regulatory knowledge, and the ability to educate diverse teams on ACA requirements. Hybrid work schedule with days 8am-4pm.