The Dental Regulatory and Compliance Senior Manager is responsible for ensuring a culture of compliance and adherence to regulatory requirements for dental operations. This includes collaborating with internal and external stakeholders to identify new and changing regulations and ensuring successful implementation. This role will develop and oversee monitoring activities to measure adherence to requirements, while developing effective remediations plans for opportunities for improvement.
Duties and Responsibilities:
- Business lead for external and internal regulatory reporting, surveys, audits, and investigations impacting dental operations
- In partnership with the business and key partners, continuously drive a strong culture of compliance
- Directs, investigates, and resolves regulatory compliance concerns
- Ensures compliance with existing and new rules, regulations, and revisions, as set forth by federal and state law
- Identifies improvement opportunities to ensure compliance with company standards, policies and procedures, as well as federal, state, and local regulations.
- Develops and oversees monitoring activities, using appropriate tools and monitoring techniques, to ensure compliance
- Acts as lead in identifying and prioritizing areas of risk and opportunity, while providing recommendations that influence business solutions
- Prepares and disseminates reports on audit and monitoring findings, along with corrective and preventative action recommendations
- Provides guidance to the business to ensure documents, projects, processes, or initiatives stay in sync with regulatory requirements and enterprise policy
- Maintains up to date knowledge of federal and state requirements and practices to perform tasks and duties
- Fosters and maintains good working relationships with leadership and other stakeholders
- Additional duties as necessary
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Minimum Qualifications:
- Bachelor's degree from an accredited institution with 4 or more years of related experience, or 10 or more years of related experience in lieu of a degree. Relevant experience includes compliance, risk, legal or audit within the health insurance industry
- Demonstrated experience working in a highly regulated environment
- Proven ability to apply advanced knowledge of regulatory compliance to consult and provide insight and guidance
- Experience in conducting delegated vendor oversight, monitoring compliance activities, and developing effective corrective action plans.
- Expert (oral and written) communication to provide effective challenge to compliance risk matters, document work performed in a clear/concise manner, as well as prepare reports and presentations for management
- Intermediate to advanced knowledge of Microsoft Office tools including Word, Excel, and PowerPoint
Preferred Qualifications:
- Advanced knowledge of compliance laws, regulations, and regulatory expectations in dental utilization management, appeals and claims
- Strong organizational skills
- Ability to foster a culture of compliance
- Demonstrated professionalism and leadership skills along with the ability to develop, direct and support a team
Compliance & Regulatory Responsibilities: Noted above.
License/Certification: N/A
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.
EEO Law Poster and Supplement
All hiring and recruitment at Healthfirst is transacted with a valid "@healthfirst.org" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.
Hiring Range:
- Greater New York City Area (NY, NJ, CT residents): $119,900 - $183,430
- All Other Locations (within approved locations): $102,600 - $156,655
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.