At Memorial Hermann, we're about creating exceptional experiences for both our patients and our employees. Our goal is to provide opportunities for our diverse employee population that develop and grow careers in a team-oriented environment focused on patient care.
Every employee, at every level, begins their journey at Memorial Hermann learning about the history of the organization and its established culture built on trust and integrity. Our employees drive this culture, and we want you to be a part of it.
Responsible for day-to-day regulatory and compliance requirements for the organization's health plan and insurance company under general supervision. Provides specialized skills and expertise to review, analyze, and assist the organization's compliance with a broad array of complex and routine managed care and insurance regulatory requirements. Typically reports to Director of Compliance.
Education: Bachelor degree required; Certified Legal Assistant (CLA) designation preferred
Licenses/Certifications: Required to obtain a current; unrestricted Texas Group 1 License within eighteen (18) months of hire date
Experience / Knowledge / Skills:
- Five (5) years of experience analyzing, monitoring, and assuring regulatory compliance for a Managed Careorother Insurance organization
- Two (2) years of project management experience requiring strong interpersonal skills, detail orientation, excellent communication skills, strong Microsoft Office computer proficiency, time management, and analytic skills
- Knowledgeable and compliant with all relevant laws, rules regulations and accreditation standards and requirement
- Demonstrates commitment to the Partners-in-Caring process by integrating our culture in all internal and external customer interactions; delivers on our brand promise of "we advance health" through innovation, accountability, empowerment, collaboration, compassion and results while ensuring one Memorial Hermann.
- Ensures the organization is in compliance with Texas Department of Insurance (TDI) regulations, processes, accurate and timely filings, and other applicable regulatory or compliance requirements.
- Manages processes required to assure compliance with production of Certificates of Coverage, Policies, Advertising and Sales Material, and Summary of Benefit Coverage.
- Responsible for regular and consistent tracking, monitoring, and interpreting of applicable regulatory and compliance requirements, enforcement trends and developments to keep abreast of applicable rules, regulations, and laws governing the administration of all health plan and insurance company programs.
- Develops, reviews, updates, archives, and publishes compliance policies, standards, and procedures.
- Evaluates compliance program effectiveness, participates in and leads periodic audits, and prepares and implements training required to support compliance program objectives.
- Assists with development of new products for fully insured and self-funded market and management of Pharmacy Business Management (PBM) integration.
- Works collaboratively with legal team, health plan and insurance company staff to review, analyze, and assure policy language complies with agreed upon benefits, certificates of insurance are accurate, and internal teams are administering benefits plans as required by contractual terms.
- Communicate, collaborate and cooperate with internal and external stakeholders.
- Adheres to all Compliance/Program Integrity requirements.
- Complies with HIPAA Regulations
- Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
- Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
- Other duties as assigned.