Compliance Manager
United StatesFull-TimeManager
Salary not disclosed
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Job Details
- Experience
- Ten (10) years significant business experience, or ten (10) years of industry experience
- Required Skills
- SharePointMicrosoft Office
Requirements
- Bachelor's degree in business administration or related field
- Ten (10) years significant business experience or ten (10) years of industry experience
- Significant experience in research and interpretation of Workers' Compensation state managed care plans and medical bill review requirements
- Proficiency with Microsoft Office applications
- Proficiency with SharePoint
- Proficiency with Office 365
- Excellent oral and written communication skills
- Excellent organizational/time management skills
- Experience writing briefs and/or position papers
Responsibilities
- Manage all state-managed care plans
- File new applications and modify existing applications as needed
- Manage the implementation process both internally and externally with clients and state liaisons
- Regularly review medical bill review state reporting laws and regulations, maintaining documentation on Risingpedia Timely Pay site
- Oversee the coordination of resources to ensure the ongoing effectiveness of the state managed care programs
- Track applicable laws and regulations in jurisdictions where Rising participates in state managed care plans
- Track applicable medical bill review laws and regulations nationwide
- Develop and maintain managed care resource materials for Rising state filings and customer worksite materials
- Perform managed care report filings as required quarterly, semi-annually
- Maintain historical archive of customer managed care filings
- Manage the California MPN Coordinator team of Medical Access Assistants
- Maintain the timely pay portal, regularly reviewing state regulations and rules for Medical Bill Review
- Manage Rising’s fraudulent provider workflow and team
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