Help us maintain the quality of jobs posted on PowerToFly. Let us know if this job is closed.
Job Type
Full Time
Job Details
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
- 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
- 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
- Greater New York City Area (NY, NJ, CT residents): $119,900 - $183,430
- All Other Locations (within approved locations): $102,600 - $156,655
Learn more about Healthfirst, Inc.