Job Summary:The Specialist, Data Compliance – Indiana is responsible for ensuring all Healthy Indiana Plan (HIP) and Hoosier Healthwise (HHW) data conforms to Indiana Family & Social Services Administration (FSSA) and Office of Medicaid Policy & Planning (OMPP) data standards and policies.
Essential Functions:- Ensure all Healthy Indiana Plan (HIP) and Hoosier Healthwise (HHW) data conforms to Indiana Family & Social Services Administration (FSSA) and Office of Medicaid Policy & Planning (OMPP) data standards and policies
- Manage data quality, change management and data exchanges with FSSA, OMPP, or its designees
- Responsible for data quality and verification, data delivery, change management processes used for data extract corrections and modification and enforcement of data standards and policies for data exchanges to FSSA & OMPP as defined by the state
- Coordinate with the State and Indiana Market to implement data exchange requirements
- Lead data quality and verification, data delivery, change management processes used for data extract corrections and modifications and enforcement of data standards and policies for data exchanges to the FSSA and OMPP as defined by the state.
- Ensure HIPPA and regulatory compliance rules are addressed for all data movement
- Drive ETL standards and practices toward establishing and following data quality standards as set forth by the FSSA and OMPP
- Work with business areas and IT to ensure integrity and proper integration for all sources of enterprise data
- Prioritize team activities based upon Data Management team priorities and bandwidth
- Work closely with areas directly connected to the Enterprise Data Warehouse to ensure that reporting, business intelligence, and analytic data needs are met
- Assist data analytics of regulatory compliance activities including audit and monitoring results and regulatory complaints and grievances
- Lead analysis of new and changes to regulatory requirements to identify downstream impacts and system, people and process opportunities impacting Indiana market
- Perform any other job related duties as requested.
Education and Experience:- Bachelor's degree required
- Equivalent years of relevant work experience may be accepted in lieu of required education
- Three (3) years Managing data quality and data exchange processes including data integration and data verification required
- Healthcare experience required
- Experience in data management functions in a multi-faceted environment preferred
Competencies, Knowledge and Skills:- Knowledgeable in health care data and health care data exchange standards
- ETL architecture and design
- SQL Server knowledge required
- Metadata solutions or tool experience preferred
- Communication skills both written and verbal
- Knowledge of managed care preferred
- Knowledge of healthcare data coding such as CPT-4, HCPCS, ICD-9, DRG and Revenue Codes a plus
- Ability to work independently and within a team environment
- Critical listening and thinking skills
- Decision making/problem solving skills
- Training/teaching skills
- Indiana Medicaid knowledge preferred
Licensure and Certification:Working Conditions:- Work from home; may require to attend meetings in office
- Up to 15% (occasional) Travel is not typically required
Compensation Range:
$72,200.00 - $115,500.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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