Summary: The Compliance Manager makes a difference by monitoring healthcare legislation, regulations, industry guidance and standards as they apply to the company’s products and services. The position is responsible for advising the company’s business units on regulatory requirements and approaches to maximize the effectiveness of products and services to meet client regulatory requirements. This key individual provides regulatory guidance and support in the development of healthcare solutions and services, with a focus on the payer, provider and health system markets.
Monitoring, researching and defining applicable healthcare regulatory requirements and industry standards for our products and services.
Having an acute understanding of regulatory processes and its relationship to Cognizant solution lifecycles.
Proactive reviews of healthcare industry newsletters, regulatory journals and “happenings” to stay informed of changing standards and the future of regulatory compliance; keeping in mind the goals of identifying potential risks and consideration of strategic impacts for Cognizant solutions.
Evaluate regulatory impacts on end-to-end solutions providing strategic input across multiple solutions.
Performing regulatory requirement walkthroughs and training sessions so stakeholders are informed of the impact(s) of healthcare regulations.
Creating and assisting in the creation of business cases to support the development of the product and services to meet compliance requirements.
Working with customers and internal resources, develops requirements using interviews, documents analysis, workshops, business process descriptions, use cases, scenarios, business analysis, competitive product analysis, task and workflow analysis.
Leading requirements analysis and quality assurance reviews, ensuring that requirement statements are complete, consistent, traceable, feasible, and verifiable.
Writing requirements specifications according to standardized templates, using natural language simply, clearly, unambiguously, and concisely.
Manage changes to base line requirements through effective application of change control processes and tools.
Participating in peer reviews and inspections of requirements documents.
Providing regulatory activities/issues reports to management on a regular basis.
Coordinating and investigating matters related to regulatory compliance.
Responding to requests from cross functional business units for detailed regulatory guidance to assist in product, service and solution portfolio definition/development and strategy as it relates to healthcare regulatory matters
Delivering presentations regarding regulations and industry standards to executive management, customers and other audiences, as required.
Developing, coordinating and participating in employee education and training programs.
Contributing to the development and maintenance of regulatory services department procedures and offering suggestions for process improvement.
Complying with applicable regulatory laws/standards and company policies and procedures.
Experience with Government Lines of Business, HIPAA, and other CMS and regulatory requirements operationalization.
Knowledge of healthcare regulations applicable to payers, providers and health systems.
Requires the ability to analyze, write and integrate highly technical information into requirements and action plans; ability to effectively communicate to a variety of audiences including clients and senior management.
Experience with requirements elicitation, analysis, specification, verification, and management practices. The ability to apply them in practice is essential.
Strong analytical, oral and written communication skills required
A minimum of 5 years of healthcare business experience in payer or provider healthcare IT products and services markets.
Requires a BA/BS degree in a related field
Knowledge of healthcare regulations applicable to healthcare provider and consumers.
Quality measures, standards and reporting requirements for health care payers
Knowledge of industry standards and best practices in healthcare operations preferred.
Demonstrated experience with: risk assessment, internal audits, process flowcharting, business process review and providing written and verbal communications of results to supervisors.
Technical knowledge of healthcare IT solutions preferred