Provider and Network Compliance Manager

HealthPartners • Bloomington, MN

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About The Position

HealthPartners is hiring a Provider and Network Compliance Manager. The Provider and Network Compliance Manager serves as an organizer, facilitator, planner, and problem solver for compliance-related projects across Provider Electronic Commerce and Operations and the Contracted Care Division. This role oversees government and regulatory compliance for health plan providers and networks, ensuring adherence to contracts and policies and procedures. The position also supports strategic initiatives, network adequacy filings, and HIPAA compliance projects, acting as a liaison between internal departments and external regulatory bodies.

Requirements

• Bachelor’s degree in Business or Health Care Administration, or another related field
• 5 years of experience in managed health care/insurance industry
• 3 years of Project management
• Experience utilizing Excel and Power BI reports and dashboards to analyze data
• Solid understanding of accreditation and regulatory requirements related to Medicare, Medicaid and individual market health insurance exchanges

Nice To Haves

• Master’s degree in Business or Health Care administration
• Health Care Compliance certificate
• Experience with health provider contracting processes
• Supervisory or personnel management experience
• Understanding of Agile development or continuous improvement methodologies

Responsibilities

• Manage governmental and regulatory compliance including implementing and enforcing policies and procedures
• Manage network compliance related to adequacy, data accuracy, filings, monitoring and directories
• Oversee audit responses related to provider contracts and provider data needs
• Manage compliance with NCQA guidelines
• Regulatory tracking, analysis, implementation and ongoing guidance
• Leading regulatory update communications to the health plan contracted providers.
• Ensuring cross-functional alignment, providing visibility and escalating key decision-making/risk assessment to senior leadership and the legal department.
• Utilizes reporting to manage data accuracy, monitor compliance rates and network configuration

What This Job Offers

• Job Type: Full-time
• Career Level: Manager