Government Programs Regulatory Reporting Lead

Sanford Health • Sioux Falls, SD

121d • $32 - $52 • Remote

About The Position

The Government Programs Regulatory Reporting Lead will serve as the subject matter expert for regulated reporting and audit readiness of the Government Program products, including Medicare Advantage, ACA, and Medicaid, to ensure we are meeting all State and Federal regulations and time frames, and in accordance with Sanford Health Plans policies. This includes, but is not limited to assisting with questions related to data submissions, internal validations, and other tasks as assigned.

Requirements

• Bachelor's degree in health care, finance or a related field.
• Minimum five years of relevant experience required.

Nice To Haves

• A background or experience in health care reimbursement or contract negotiations preferred.

Responsibilities

• Manages reporting, auditing, and data exchange of the government programs - Medicare Advantage, ACA, and Medicaid, in support of business objectives.
• Works collaboratively with operational units to ensure the products are accurately defined, communicated and configured; all member communications are compliant and data exchanges and reports are accurate, timely and meet State and Federal requirements.
• Serves as the main point of contact for all reporting related questions, issues, and interpretation.
• Leads in the development, implementation, process improvement, and education of the government program products.
• Leads in ensuring certifications, quality reporting, member materials and website content, and regulatory and statutory standards and requirements are met.
• Carries out operational policies and procedures that support organizational improvements and comply with Federal and State requirements.
• Other special projects as assigned.

What This Job Offers

• Job Type: Full-time
• Industry: Hospitals
• Education Level: Bachelor's degree