Sr. Regulatory Reporting Specialist – Hybrid

Job Description

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion. Primary Purpose The Sr. Regulatory Reporting Specialist ensures the organization maintains robust compliance with state and federal regulatory requirements through comprehensive oversight of reporting obligations, audit coordination, and regulatory monitoring activities. This role focuses on developing data-driven dashboards and tracking systems to proactively monitor regulatory reporting performance and prevent potential compliance issues. Minimum Specifications Education Bachelor’s degree in business administration, healthcare administration or related discipline required. Master’s degree in business administration, healthcare administration or related discipline preferred. Experience Seven (7) years of experience in a managed care organization. Knowledge of and compliance experience in Medicaid is required. Equivalent Education and/or Experience May have an equivalent combination of education and experience to substitute for both the education and the experience requirements. Skills or Special Abilities Knowledge of Medicaid Managed Care and health plan administration. Design and maintain reporting dashboards that analyze complex data, identify emerging trends and patterns, and enable proactive detection of potential non-compliance issues before they become regulatory concerns. Ability to use problem solving skills and interpret statistics to systematically analyze problems, draw relevant conclusions, and devise appropriate plan of action. Experience providing highly complex analysis, defining efficiencies in relation to compliance programs and internal controls. Development of audit tools and methodology for pulling random samples to conduct audit work plans. Must be able to write detailed reports of findings and recommendations. Knowledgeable and compliant with all relevant laws, rules regulations and accreditation standards and requirement (TDI, HHSC, NCQA, CMS) Strong analytical ability with attention to detail to ensure all regulatory requirements are met. Excellent verbal and written communication skills. Must be able to write professional audit reports. Thorough knowledge of healthcare compliance regulations, particularly those pertaining to Texas Medicaid managed care organizations, and demonstrated experience in compliance program management within a healthcare setting. Responsibilities Reporting Create and maintain a regulatory reporting dashboard to monitor submission deadlines, track completion status, and measure performance against state agency reporting requirements. Manage the regulatory reporting calendar and coordinate with departments to ensure timely, accurate submission of all required reports to state agencies, including quarterly and annual filings, encounter data submissions, and ad-hoc regulatory requests. Develop and maintain documentation of regulatory reporting processes, submission procedures, and controls to ensure consistent compliance with evolving requirements and standards. Regulatory and Compliance Oversee the development and execution of corrective action plans in response to identified areas of non-compliance, ensuring proper implementation, monitoring progress, and providing regular status updates to leadership and regulatory bodies. Lead and coordinate responses to external regulatory audits, including all HHSC/TDI/OIG requests and readiness assessments, by organizing documentation requests, managing submission timelines, and serving as the primary liaison between auditors and internal departments. Maintain comprehensive audit documentation and work papers in accordance with regulatory retention requirements and organizational policies, ensuring proper organization, security, and accessibility of compliance records. Monitor regulatory changes and new requirements affecting Texas Medicaid managed care organizations, assessing potential impacts, and recommending necessary operational adjustments. Partner with business units to implement and enhance compliance controls, providing guidance on regulatory requirements and ensuring processes align with state and federal regulations. Ensures work is carried out in compliance with regulatory and/or accreditation standards as well as contractual requirements. Coordinates cross-functionally to manage timely submissions while serving as a key liaison with external regulatory bodies. Implements effective compliance processes and corrective actions, maintaining thorough documentation of all compliance activities. Supports general compliance initiatives and special projects as assigned to promote a culture of compliance throughout the organization. Quality Integrate health literacy principles into all communication including Members and Providers. Support strategies that meet clinical, quality and network improvement goals. Promote the use of Health Information Technology to support and monitor the effectiveness of health and social interventions and make data-driven recommendations as needed. For staff in clinical roles, foster collaborative relationships with members and/or providers to promote and support evidence-based practices and care coordination. Professional Accountability Promotes and supports a culturally welcoming and inclusive work environment. Acts with the highest integrity and ethical standards while adhering to Parkland’s Mission, Vision, and Values. Adheres to organizational policies, procedures, and guidelines. Completes assigned training, self-appraisal, and annual health requirements timely. Adheres to hybrid work schedule requirements. Attends required meetings and town halls. Recognizes and communicates ethical and legal concerns through the established channels of communication. Demonstrates accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information. Maintains confidentiality at all times. Performs other work as requested that is reasonably related to the employee’s position, qualifications, and competencies. Job Accountabilities Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of PCHP. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices. Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding. Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status. As part of our commitment to our patients and employees’ wellness, Parkland Health is a tobacco and smoke-free campus.