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Compliance Monitoring Manager

Zelis

Zelis

Legal
Boston, MA, USA · Atlanta, GA, USA
Posted on Wednesday, September 13, 2023

Responsibilities:

  • Develop and execute a comprehensive compliance monitoring and testing program to evaluate adherence to regulatory and contractual requirements.
  • Conduct regular reviews of internal processes, systems, and data handling procedures to identify potential compliance gaps or deficiencies.
  • Collaborate with relevant stakeholders to assess and analyze compliance risks, emerging trends, and regulatory changes that impact the consumer reporting industry.
  • Design and implement monitoring protocols, including the development of key risk indicators (KRIs), testing methodologies, and sampling techniques.
  • Perform compliance testing and reviews to evaluate the effectiveness of controls, identify non-compliance issues, and recommend corrective actions.
  • Prepare detailed reports and documentation of compliance monitoring activities, findings, and recommendations for management and regulatory bodies.
  • Stay up to date with industry best practices, regulatory requirements, and advancements to proactively identify areas for improvement and enhance the compliance framework.

Skills:

  • Management and leadership
  • Ability to embrace complexity
  • Ability to develop standards for maintaining regulatory and contractual compliance
  • Organization, project management, and strategic planning skills
  • Familiarity with process improvement methodology
  • Demonstrated accountability and keen ability to meet aggressive time frames
  • High degree of professional ethics and integrity
  • Sound judgment and ability to analyze situations and information
  • Excellent verbal communication and documentation skills
  • Attention to detail
  • Understanding of regulatory frameworks
  • Possess strong project management skills with the ability to manage projects against deadlines
  • Maintain a professional demeanor and confidentiality in sensitive situations
  • Recognized as a collaborative business partner with various departments throughout the organization
  • Experience in the development and implementation of a compliance program related to government programs
  • Resourceful and pro-active team player with strong follow-through

Experiences/Background:

  • BA or BS in business management, or similar field
  • 3+ years Managerial experience
  • At least 5 years experience in the healthcare industry and/or compliance with a level of understanding and knowledge of industry practices
  • Knowledge of compliance regulations and compliance monitoring techniques
  • Experience working with Centers for Medicare and Medicaid Services

As a leading payments company in healthcare, we guide, price, explain, and pay for care on behalf of insurers and their members. We’re Zelis in our pursuit to align the interests of payers, providers, and consumers to deliver a better financial experience and more affordable, transparent care for all. We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, over 4 million providers, and 100 million members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.

Commitment to Diversity, Equity, Inclusion, and Belonging
At Zelis, we champion diversity, equity, inclusion, and belonging in all aspects of our operations. We embrace the power of diversity and create an environment where people can bring their authentic and best selves to work. We know that a sense of belonging is key not only to your success at Zelis, but also to your ability to bring your best each day.

Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

We encourage members of traditionally underrepresented communities to apply, even if you do not believe you 100% fit the qualifications of the position, including women, LGBTQIA people, people of color, and people with disabilities.

Accessibility Support

We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email TalentAcquisition@zelis.com

SCAM ALERT: There is an active nationwide employment scam which is now using Zelis to garner personal information or financial scams. This site is secure, and any applications made here are with our legitimate partner. If you’re contacted by a Zelis Recruiter, please ensure whomever is contacting you truly represents Zelis Healthcare. We will never asked for the exchange of any money or credit card details during the recruitment process. Please be aware of any suspicious email activity from people who could be pretending to be recruiters or senior professionals at Zelis.