Kelsey-Seybold Clinic, a Houston tradition in patient-centered care, is a multi-specialty clinic with 21 locations and is comprised of more than 400 physicians providing primary and specialty care in a collaborative manner.
With more than 40 different clinical and non-clinical specialties, you can design a career path at Kelsey-Seybold Clinic that allows you to grow your future in a completely new direction.
The Manager of Compliance and Regulatory Affairs supervises the Credentialing process for the Health Plan and overseas each of the delegated entities to ensure all CMS, TDI and credentialing standards are being maintained. He/she develops and implements delegation over-site audits for compliance and other projects to meet the requirements of CMS, Texas Department of Insurance, NCQA and AAAHC. He/she is instrumental in providing strategic management of regulatory affairs and compliance functions to include the licensing of the health plan, license expansions, regulatory policies, procedures, and development and implementation of internal controls. This position oversees TDI and CMS audits and collaborates with the leadership team on decisions and policy changes related to new legislation or changes in current legislation, licensing requirements and federal regulations. This position is responsible for supporting the Director of Compliance in the identification of compliance risks associated with health plan operations and the development of best practices to mitigate risk. This position will be responsible for the development of internal controls to detect, correct and prevent fraud, waste and abuse and the assessment and mitigation of integrity, compliance and privacy risks as it relates to operations within the health plan. The Manager of Compliance and Regulatory Affairs is responsible for policy development, management reporting, collection and analysis of data from delegated entities and the development and presentation of educational programs to improve compliance training programs. The Manager works in a matrix relationship with the Director of Managed Care, Vice President of KelseyCare Advantage and the Medical Director of the Plan.
Consider Kelsey-Seybold Clinic
If you want a satisfying career and a rich, rewarding personal life, don’t choose between them.
Achieve them both at Kelsey-Seybold Clinic. Kelsey-Seybold.com/Careers
As the 4th largest city in the U.S., Houston, Texas is a leader in business, entertainment, the arts and more. From professional sports to outdoor fun to an out-of-this-world space experience and incredible dining - it's all here! Stroll the beaches of Galveston or challenge yourself on one of our many golf courses. Space City offers everything from breathtaking museum exhibits to vibrant downtown entertainment. Explore the wonder of space or spend the day shopping to your heart's content. Houston is a city of infinite possibilities.
We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status.
Bachelor’s degree or equivalent work experience
3-5 years health plan experience in compliance or regulatory affairs department
Knowledge of ICD-9 Coding methodologies, Managed Care payment methodologies, proficient in MS office products, and process improvement methodology
Excellent written and verbal communication skills
Prior experience with CMS or TDI
Previous supervisory or management experience
Internal Number: 21007
About Kelsey-Seybold Clinic
Kelsey-Seybold Clinic is Houston's premier multispecialty group practice, founded in 1949 by Dr. Mavis Kelsey in Houston's famous Texas Medical Center. More than 400 physicians and allied health professionals’ practice at 21 locations and an accredited Sleep Center in the Greater Houston area. Medical services offered by Kelsey-Seybold include medical care in 55 medical specialties including primary care and specialty care, outpatient surgery centers, an accredited Sleep Center, a Radiation Therapy Center, laboratory services, advanced radiology services and other diagnostic services, 15 on-site Kelsey pharmacies and a secure web portal for patients to communicate with their Kelsey-Seybold doctors, get test results and schedule appointments.