Exl Service

  • Regulatory Clinical Compliance Administrator

    Job Location US-FL-Tampa
    ID
    2019-6415
    Group
    Operations Management
    Type
    Regular Full-Time
  • Overview

    Why join EXL?
    At EXL, were more than just an analytics, operations management, and technology Company. We focus not only on our outstanding Team Members, but on our growing industry as well.
    Headquartered in NYC, EXL has more than 27,000 professionals situated in locations throughout the United States, Europe, Asia, Latin America, and South Africa.

    Our EXL Team Members receive the benefit of:
    Valuable Compensation Package:
    • Competitive Wages
    • Work-Related Expense Reimbursement
    • Annual Discretionary Bonuses
    • Team Member Referral Bonuses

     

    Comprehensive Health & Welfare Benefits:
    • Group Medical, Dental and Vision Benefits
    • Flexible Spending Accounts and Health Savings Accounts
    • Generous Paid Time Off, Sick Days and Holiday Pay
    • Group Life Insurance, LTD and 401k Retirement

     

    Inviting Culture & Team-Oriented Philosophy:
    • Exciting Work Environment
    • Casual Dress Code
    • Monthly Team and Company Events
    • Team Member Appreciation Awards
    • Remote, Home-Based Opportunities
    • Opportunities for Upward Mobility

     

     

     

     

    The Regulatory Clinical Compliance Administrator is responsible for the development, organization, and maintenance of documentation that supports the organization’s utilization review licensure filings, certifications and/or authorizations from state and federal agencies.

    Responsibilities

    • This position assists with all utilization licensure, compliance and regulatory activities of the company, including but not limited to:
      • Accountable for obtaining and managing state utilization licenses and certifications in support of ESTS.
      • Perform legal research on federal, state and statutes to update corresponding policies and procedures. Promote regulatory compliance in various jurisdictions where the company conducts business.
      • Responsible for the submission and filing of material UR changes in HI's UR Policies and Procedures, to applicable state departments, within required time frames.
      • Monitor List Serves in the states ESTS conducts business. Identify changes and modifications in regulations and disseminate to appropriate individuals and departments.
      • Participate appropriate committees to present regulatory updates, as it relates to the company’s operations.
      • Formulate ongoing research, development, organization, and maintenance of program documentation to reflect organization’s compliance with state and federal laws, rules and regulations and explain regulations and statutes in monthly meetings.
      • Oversees the ongoing development, organization, documentation, and maintenance of various data sources to reflect the company’s current status as it relates to regulatory affairs.
      • Responsible for continuous maintenance of appropriate HI policies and procedures located on the portal.
      • At predetermined intervals, may request audit universe and/or information from operations. Audit requests may be based on CMS, state or contract requirements.
      • Other duties, as assigned.

     

    Qualifications

    Experience in the Healthcare Industry, regulatory environment, managed care, industry standards, and insurance regulations strongly preferred

     

    Education
    RN with a current, unrestricted license to practice as a health professional preferred 

     

    Work Experience Requirements:
    • Effective problem-solving skills are essential.
    • Strong written and communication skills.
    • Adeptness to evaluate processes and make recommendations for change, when opportunities for improvement are identified.
    • Able to understand Federal and State laws, affecting products and services of the Healthcare industry.
    • Ability to read, interpret and apply legal statutes.
    • Well-organized and detailed oriented.
    • Great computer skills.
    • Regular, dependable attendance

    EEO Statement

    EEO/Minorities/Females/Vets/Disabilities

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