
Chief Healthcare Regulations Specialist
1 day ago
We seek a skilled professional to gather, analyze, and document business requirements related to healthcare regulations.
Key Responsibilities:- Gather and Analyze Requirements: Collect and document business requirements for HIPAA, CMS, NCQA, and state-specific regulations.
- Maintain Compliance: Verify that system changes, processes, and documentation remain compliant with healthcare regulations and payer guidelines.
- Liaise with Teams: Act as a liaison with compliance and legal teams during audits or regulatory updates.
- Benefit Codes & Plan Configuration: Analyze and configure benefit codes for medical, dental, pharmacy, and specialty products.
- Support Plan Design: Collaborate with product and IT teams to ensure accurate coding, claims adjudication, and eligibility processing.
- Collateral & Member Materials: Coordinate development and validation of member-facing collateral such as Explanation of Benefits (EOBs), Summary of Benefits and Coverage (SBCs), provider directories, and plan brochures.
This role offers an exciting opportunity for a detail-oriented professional to make a significant impact in the healthcare industry.
Skill Requirements: The ideal candidate will have strong analytical skills, excellent communication abilities, and experience working with healthcare regulations. Proficiency in benefit analysis, compliance management, and team collaboration is highly valued.
Why Apply: This position provides a unique chance to work on high-profile projects, develop your expertise, and contribute to the growth of our organization.
About Us: Our organization specializes in providing innovative solutions for the healthcare industry. We strive to create a collaborative environment where our employees can grow professionally and personally.
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