Compliance Specialist

Community First Health Plans; San Antonio (TX); On-site; USD 65,000 - 90,000; Full time

Job summary

Community First Health Plans seeks a Compliance & Regulatory Specialist to help oversee and execute compliance across operations and delegated activities. You will coordinate regulatory deliverables and assist with interpreting changes in guidelines, including HIPAA, to improve transparency and accountability.

The role requires familiarity with Texas Medicaid, TDI, CMS, and related regulatory bodies, plus strong MS Office skills. A related bachelor’s degree or equivalent experience is preferred.

Qualifications

• Bachelor's degree in business administration, public administration, health care administration or a related field.
• Proficiency in Microsoft Office applications.

Responsibilities

• Assist in oversight and execution of compliance in the health plan's operational areas.
• Coordinate and facilitate the execution of regulatory deliverables.
• Interpret and implement changes in regulations and guidelines, including HIPAA.

Education

Bachelor's degree in business administration, public administration, health care administration or related field

Tools

Microsoft Office

Job description

POSITION SUMMARY/RESPONSIBILITIES

The Compliance & Regulatory Specialist is responsible for assisting in the oversight and execution of compliance in the health plan’s operational areas, including delegated operational activities and regulatory reporting. The candidate must be familiar with current Texas Medicaid regulations, the Texas Department of Health and Human Services, Texas Department of Insurance (TDI) regulations, the Office of Inspector General (OIG) Compliance Plan, the Centers for Medicare and Medicaid Services (CMS) and should also be familiar with health plan documents such as Summaries of Benefits and Coverage, Schedules of Benefits and Certificates of Coverage. This position will coordinate and facilitate the execution of the company’s regulatory deliverables. The Compliance & Regulatory Specialist will assist with the interpretation of and/or execution of changes in regulations and guidelines, including HIPAA. This position will need to build key relationships with regulatory agencies and internally to facilitate improved interaction, transparency and accountability.

EDUCATION/EXPERIENCE

A bachelor's degree in business administration, public administration, health care administration or a related field is desired but will accept experience in lieu of education. Proficiency in Microsoft Office applications.