Regulatory Reporting Specialist - Business | Remote - AmeriHealth Caritas : Job Details

Your career starts now. We're looking for the next generation of healthcare leaders.

At AmeriHealth Caritas, we're passionate about helping people get care, stay well ,and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com .

**Responsibilities:**

Under the general supervision of the Director of Regulatory Reporting, the Regulatory Reporting Specialist - Business is responsible for ensuring that all state reporting requirements are identified and interpreted and a business solution is developed while ensuring accurate and timely compliance with all state reporting requirements/deadlines.

- Provides leadership and oversight in the development and implementation of business and technical solutions utilized to complete reporting requirements while ensuring that the report completion process remains both accurate and efficient.

- Through report review or verification process, identifies and implements process or system enhancements that may lead to improved data integrity, efficiencies, or consistencies. Identifies appropriate internal or external contacts and coordinates the development of work groups and plans of action to ensure successful resolution and implementation of enhancements identified.

- Participates in inter-departmental teams to ensure that Regulatory Reporting needs are communicated and data is not compromised when business procedures are modified and, if affected, works with the team to develop alternate solutions to ensure data integrity is not impacted.

- Develops and maintains a strong working relationship with regulatory agencies, joint venture contacts or subcontractors by attending required meetings and/or on-site visits.

- Proactively maintains relationships with plan and/or ASA/MSA customers to ensure their Regulatory Reporting requirements are met. Acts as a resource to local office management regarding Regulatory matters.

- Reviews and approves reporting, presents reporting, and obtains necessary approvals from the Director, Regulatory Reporting, or other business owners as required.

- In conjunction with the Director of Regulatory Reporting, develop and implement a formalized Regulatory Reporting staff training program. Training to include the development and maintenance of a procedure and reference manual, formalized group training plan for new staff and ongoing training of existing staff on new policies/procedures and reporting requirements.

- Reviews, researches, and coordinates prompt responses to correspondence and inquiries from stakeholders, clients, or regulatory agencies.

- Develops and maintains a strong knowledge of all data sources (including, but not limited to, the Data Warehouse, the Facets System, and the Reports Database) available for reporting.

- Reviews, researches, and interprets Request for Proposals (RFPs) and other contractual agreements to ensure effective identification of all regulatory requirements. Related issues are identified, escalated, and resolutions or workaround plans formulated.

- Ensures the Director of Regulatory Reporting is informed of reporting compliance and related issues via weekly status updates, ad-hoc discussions/meetings, or written correspondence.

- Oversees the testing of each reporting solution developed to ensure the accuracy of the data reported.

- Works with staff to ensure that the report completion criteria and process are documented in a user-friendly manner.

**Education/Experience:**

- Bachelor's Degree or equivalent.

- 6 years of Data Analysis, Reporting, Claims, Managed Care, or Healthcare environment required.

- 2 years of Project Management preferred.

- Proficiency in Microsoft Access, Excel, Word, and Relational Database Design.

- Basic knowledge of SQL or VBA programming a plus.

- Thorough understanding of business computer programs, applications and systems, database structures, and data files required.

- Ability to train staff in all aspects of Regulatory Reporting and to provide continued updates as policies and procedures change.

- Complete understanding of reporting or data analysis processes.

- Strong communication (both written and verbal), analytical, and problem-solving skills.

- Strong organizational skills with the ability to coordinate several projects simultaneously.

- Understanding of claims processing, clinical coding, and basic business practices is preferred.

**Diversity, Equity, and Inclusion**

At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable being themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

**Our Comprehensive Benefits Package**

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.