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The Compliance Specialist will oversee the Compliance Program operations, facilitate training, manage documentation, and ensure regulatory compliance across the organization.

Supervises and implements the Compliance Program, ensuring adherence to regulations, coaching the team, leading initiatives, and conducting audits.

Supervise compliance operations, manage the compliance team, coordinate compliance initiatives, and ensure adherence to regulations and internal policies. Monitor compliance effectiveness and assist in audits and training.

Lead compliance functions for Government Programs utilization management, ensuring adherence to URAC/NCQA standards and preparing for audits.

The PCDH Coordinator oversees the Patient Centered Dental Home program, ensuring member education, managing provider relationships, and enhancing dental service utilization.

Analyze and report on claims processing using data analytics and visualization techniques. Develop dashboards, monitor KPIs, ensure data integrity, and support reporting requirements.

Lead analysis and resolution of encounter data issues, manage submissions, oversee compliance, and develop solutions for internal and external stakeholders.

Lead the implementation of government programs, serving as a liaison between compliance, business, and IT teams. Manage projects and ensure regulatory compliance for Medicaid and Medicare programs.

Analyze and resolve encounter data issues, ensuring compliance and accuracy in submissions, while maintaining strong internal and external stakeholder relationships.

Supervises the Focused Review SIU teams, ensuring compliance and efficient operations. Oversees data analysis, staff development, and strengthens partnerships with stakeholders.