Health Care Claims Compliance Manager

Job Summary

A company is looking for a Claims Compliance Manager responsible for regulatory compliance in health care claims.

Key Responsibilities

• Manage and execute mandatory compliance reporting obligations, including CMS Section 111 and RxDC reporting
• Oversee Transparency in Coverage compliance and lead Gag Clause Prohibition Attestation processes
• Act as the primary compliance resource for clients, providing guidance and monitoring regulatory updates

Required Qualifications

• 5 years of experience in health care compliance, particularly with self-funded and level-funded health plans
• Expertise in CMS Section 111 reporting, RxDC reporting, and related compliance processes
• Strong understanding of ERISA, ACA, HIPAA, and the Consolidated Appropriations Act as they relate to health plans
• Experience in drafting or reviewing Summary Plan Descriptions (SPDs) and Summaries of Benefits and Coverage (SBCs)
• Proficiency with Microsoft Office Suite and familiarity with compliance tracking tools