HealthPartners · 6 hours ago
Provider and Network Compliance Manager
Bloomington, MN
Full-time
Onsite
Senior Level
5+ years expHealthPartners is a nonprofit, integrated health care organization, and they are seeking a Provider and Network Compliance Manager. This role oversees government and regulatory compliance for health plan providers and networks, ensuring adherence to contracts and policies and procedures while supporting strategic initiatives and acting as a liaison between internal departments and external regulatory bodies.
MedicalPharmaceutical
Responsibilities
(40%) - . Manage governmental and regulatory compliance including implementing and enforcing policies and procedures
(30%) – Manage network compliance related to adequacy, data accuracy, filings, monitoring and directories
(20%) – Oversee audit responses related to provider contracts and provider data needs
(10%) – Manage compliance with NCQA guidelines
Regulatory tracking, analysis, implementation and ongoing guidance
Leading regulatory update communications to the health plan contracted providers
Ensuring cross-functional alignment, providing visibility and escalating key decision-making/risk assessment to senior leadership and the legal department
Utilizes reporting to manage data accuracy, monitor compliance rates and network configuration
Qualification
Required
Bachelor's degree in Business or Health Care Administration, or another related field
5 years of experience in managed health care/insurance industry
3 years of Project management
Experience utilizing Excel and Power BI reports and dashboards to analyze data
Solid understanding of accreditation and regulatory requirements related to Medicare, Medicaid and individual market health insurance exchanges
Preferred
Master's degree in Business or Health Care administration
Health Care Compliance certificate
Experience with health provider contracting processes
Supervisory or personnel management experience
Understanding of Agile development or continuous improvement methodologies
Benefits
Health
Time off
Retirement planning
Continuous learning opportunities
Company
HealthPartners
HealthPartners, an integrated health care organization providing health care services and health plan financing and administration, was founded in 1957 as a cooperative.
10001+ employees
H1B Sponsorship
HealthPartners has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (2)
2024 (26)
2023 (41)
2022 (37)
2021 (44)
2020 (52)
Funding
Current Stage
Late StageTotal Funding
$116M2020-05-07Debt Financing· $110M
2016-05-02Grant· $6M
Leadership Team
Penny Cermak
Executive Vice President and Chief Financial Officer
William Frey II
Research Director, Center for Memory & Aging, Neurosciences
Recent News
Canadian News Wire
2023-01-23
2022-12-07
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