Regulatory Reporting Specialist Bus

Amerihealth Caritas • ,

18h • Remote

About The Position

The Regulatory Reporting Specialist - Business ensures that state reporting requirements are identified and interpreted, business solutions are developed, and reporting is completed accurately and on time. This remote role is for candidates located in the Eastern or Central time zones of the United States.

The specialist provides leadership and oversight for business and technical solutions used to fulfill reporting requirements, and identifies opportunities to improve data integrity, efficiency, and consistency. The role works across departments and with regulatory agencies, customers, joint venture contacts, subcontractors, and internal business owners to resolve issues and maintain compliance. It also supports staff training, documents reporting processes, reviews contractual requirements, and oversees testing to ensure reporting data is accurate.

AmeriHealth Caritas is a mission-driven health care organization offering integrated managed care, pharmaceutical benefit management and specialty pharmacy, behavioral health, and administrative services. Fully remote associates must have reliable high-speed internet with at least 50 Mbps download and 5 Mbps upload. Associates working remotely in states where service is required by contract, law, or regulation may submit for reimbursement.

Requirements

• At least 6 years of experience in data analysis, reporting, claims, managed care, or a health care environment.
• Proficiency in Microsoft Access, Excel, and Word, and relational database design.
• Thorough understanding of business computer programs, applications and systems, database structures, and data files.
• Ability to train staff in regulatory reporting and provide ongoing updates as policies and procedures change.
• Complete understanding of reporting or data analysis processes.
• Strong written and verbal communication, analytical, and problem-solving skills.
• Strong organizational skills and ability to coordinate several projects simultaneously.

Nice To Haves

• Bachelor’s degree in Business, Finance, Information Systems, or a related field.
• At least 2 years of project management experience.
• Basic knowledge of SQL or VBA programming.
• Understanding of claims processing, clinical coding, and basic business practices.

Responsibilities

• Provide leadership and oversight in developing and implementing business and technical solutions for reporting requirements, ensuring report completion is accurate and efficient.
• Review and verify reports to identify and implement process or system enhancements that improve data integrity, efficiency, or consistency; coordinate contacts, work groups, and action plans to resolve and implement enhancements.
• Participate in inter-departmental teams to communicate regulatory reporting needs, protect data when procedures change, and develop alternate solutions when needed.
• Maintain relationships with regulatory agencies, joint venture contacts, and subcontractors through required meetings and/or on-site visits.
• Maintain relationships with plan and/or ASA/MSA customers to meet their regulatory reporting requirements and serve as a resource to local office management on regulatory matters.
• Review and approve reporting, present reporting, and obtain required approvals from the Director of Regulatory Reporting or other business owners.
• Work with the Director of Regulatory Reporting to develop and implement a staff training program, including a procedure and reference manual, new-staff group training, and ongoing training on policies, procedures, and reporting requirements.
• Review, research, and coordinate prompt responses to correspondence and inquiries from stakeholders, clients, and regulatory agencies.
• Maintain knowledge of available reporting data sources, including the Data Warehouse, Facets System, and Reports Database.
• Review, research, and interpret RFPs and contractual agreements to identify regulatory requirements; escalate related issues and formulate resolutions or workaround plans.
• Keep the Director of Regulatory Reporting informed of compliance and related issues through weekly status updates, ad hoc discussions or meetings, and written correspondence.
• Oversee testing of reporting solutions to ensure the accuracy of reported data.
• Work with staff to document report completion criteria and processes in a user-friendly manner.

Benefits

• Flexible work solutions, including remote options and hybrid work schedules.
• Competitive pay.
• Paid time off, including holidays and volunteer events.
• Health insurance coverage for the employee and dependents starting on Day 1.
• 401(k).
• Tuition reimbursement.
• Reimbursement may be submitted by fully remote associates residing in states where service is required by contract, law, or regulation.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed