Senior Manager, Regulatory Compliance

Job Overview
Reporting to the Head of Commercial Operation or designee, this position oversees corporate regulatory compliance, internal compliance with BHS corporate, clinical services and other divisional policies, and quality assurance/quality improvement and accreditation activities.

Duties

Compliance

• Ensure compliance with TELUS Health/BHS policies and all applicable federal and state regulations, including but not limited to ERISA, HIPAA, MHPAEA, and ACA.
• Stay current and informed on all applicable federal and state regulations and compliance requirements. Serve as liaison with BHS healthcare attorneys on legislative/regulatory matters. Recommend and implement policy changes or additions as appropriate to ensure compliance. Serve as a resource for all divisions, clients and BHS customers as appropriate.
• Manage TELUS Health (California) Ltd. Knox-Keene license, including board meetings as requested and audits.
• Develop client-specific NQTL analyses and requested, in coordination with other divisions and outside counsel as appropriate. Maintain BHS' Book of Business NQTL report.
• Oversee TELUS Health/BHS complaints and appeals processes, to include Federal External Reviews. Review all appeals and patient/provider complaints, direct Appeal Committee meetings and prepare appeal/complaint responses as appropriate.
• Conduct staff orientation and training on clinical and other policies pertinent to federal and state regulations and requirements, and quality standards. Provide ongoing guidance to staff regarding compliance and quality assurance matters.
• Maintain all state license/certification/registration flings, to include name and trademark registrations.
• Assist in the development and updating of clients' SPD's, SBC's and other benefit plan documents, and the analysis of client benefits to ensure all are MHPAEA and ACA compliant. Oversee the accurate input of benefits into the BYS system.
• Oversee the corporate accreditation process.

Quality Assurance

• Oversee corporate quality assurance activities throughout all levels of the organization. Serve on the Quality Assurance (QA) Committee. Promote adherence to corporate and divisional quality assurance policies. Recommend new policies as appropriate.
• Conduct divisional quality audits, including but not limited to regular patient chart audits. Utilize audit findings to improve care management effectiveness, corporate customer/patient satisfaction, and services across all BHS departments.
• Oversee the review and resolution of patient satisfaction survey concerns. Assist in maintaining the organization's 96% patient satisfaction rating.
• Serve as the corporate liaison for all subpoenas, lawsuits, or complaints filed against the company.

Qualifications

• Advanced degree preferred.
• 5 years' experience in healthcare compliance (Knox-Keene expertise preferred)
• 5 years' quality assurance experience
• 5 years' mental health parity experience required
• Experience in managed care/PPO environment and case management/utilization review
• Proficiency in MS Office suite
• Strong communication, organization, and problem-solving skills
• Experience in staff supervision/training and group presentations
• Ability to travel, with advance notice, up to 20% (4 days per month)

Job Type: Full-time

Pay: $120,000.00 - $150,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Experience:

• Mental Health Parity: 5 years (Required)

Work Location: Hybrid remote in Birmingham, AL 35209

Salary : $120,000 - $150,000