Compliance Specialist

Corporate Square; San Antonio (TX); On-site; USD 60,000 - 85,000; Full time

Job summary

A leading company in healthcare is seeking a Compliance & Regulatory Specialist responsible for ensuring regulatory compliance and overseeing related operations. The role requires familiarity with Texas Medicaid regulations and building key relationships with regulatory bodies to enhance accountability and transparency.

Qualifications

• A bachelor’s degree in a related field or equivalent experience.
• Familiarity with Texas Medicaid and regulatory compliance.
• Proficient in Microsoft Office applications.

Responsibilities

• Assist in oversight and execution of compliance in operational areas.
• Coordinate and facilitate the execution of regulatory deliverables.
• Build relationships with regulatory agencies.

Skills

Regulatory Compliance

Health Plan Operations

Relationship Management

HIPAA Standards

Proficiency in Microsoft Office

Education

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

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.