Job Summary:

The Manager, Compliance Regulatory Reporting is responsible for serving as the lead subject matter expert of the compliance regulatory reporting team and for ensuring all state Medicaid reporting data conforms to required data standards, policies, and timeframes and that analysis of reporting is conducted prior to submission.

Essential Functions

• Responsible for data quality and verification, data delivery, change management processes and enforcement of data standards and policies for data exchanges to state regulators
• Lead the distribution and oversight of the creation and submission of regulatory reporting requirements, technical specifications, templates and other regulatory requirements
• Identify and maintain accurate list all report business owners and producers, including report specifications
• Ensure effective line of communication with business owners and producers to provide education, training and clarification on reporting requirements and expectations
• Develop standardized processes and protocols to ensure effective management of regulatory reporting deliverables from all applicable regulators with special focus on State Medicaid Agencies
• Oversee activities of the team to ensure implementation of an effective quality review process of regulatory reports against technical specifications and regulatory requirements
• Establish consistent and regular communications with Plan Compliance Officers to review risks or issues in the PCO respective market and provide reporting of regulatory report data
• Build and maintain positive working relationships to collaborate with Medicaid Plan Compliance Officers and internal business owners on determining appropriate action and ensuring timely delivery of accurate reports
• Perform analysis and measurements of team process adherence and quality performance for all data entry and management of compliance requests in the designated compliance tools
• Identify and communicate irregular trends, recommend possible improvement opportunities, and relay information to management to be researched, when necessary
• Build and lead activities to ensure timely submission of all regulatory reports to applicable regulators
• Develop and distribute key metrics to report out on improvement on regulatory reporting accuracy and timeliness to Compliance and company leadership
• Lead and conduct data analysis on regulatory reports to identify trends, anomalies or issues related to managed care compliance or operational concerns
• Perform any other job-related instructions, as requested

Education and Experience:

• Bachelor's Degree in Mathematics, Economics, Business or related field or equivalent years of relevant work experience is required
• Advanced degree in Business, Mathematics or Law preferred
• Five (5) years of experience with healthcare analytics required (health plan preferred)
• Three (3) years regulatory experience in Medicaid Managed Care required
• Three (3) years of experience in leading analytic teams or equivalent preferred

Competencies, Knowledge and Skills:

• Proficient in MS Excel, PowerPoint and Word
• Proficient in SAS or SQL
• Exceptional analytical, problem solving and critical thinking skills
• Ability to lead in a hands-on capacity
• Ability to work collaboratively with all levels of management
• Ability to lead mission-critical, high visibility projects
• Ability to manage multiple priorities within a dynamic environment
• Mature written and verbal communications skills
• Knowledge of managed care operations and finance
• Knowledge of fee for service and value based provider reimbursement methods
• Knowledge of government healthcare programs (Medicaid, Medicare Advantage required/Marketplace, preferred)
• Knowledge of the fundamentals of pharmacy benefit management and pricing
• Knowledge of healthcare quality programs and measures (e.g. CMS, HEDIS, NCQA, AHRQ)
• Data analysis ability to produce meaningful insight and drive appropriate action
• Proven ability to effectively manage work through prioritization, preparing, effective scheduling, leveraging resources and maintaining focus
• Strong decision making and problem-solving skills
• Demonstrated success in working in a matrixed environment
• Detail orientated with focus on maintaining accurate information in tools as required
• Time management skills including creation and maintenance of project timelines

Licensure and Certification:

• Certified in HealthCare Compliance (CHC) is preferred

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:
$90,500.00 - $158,400.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type:
Salary

Competencies:
- Create an Inclusive Environment- Cultivate Partnerships- Develop Self and Others- Drive Execution- Influence Others- Pursue Personal Excellence- Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.