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Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 40 offices nationwide. Familiarity and understanding of third-party administrator operations and Taft-Hartley provisions and implications.
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Manage and maintain HACCP, SSOP, SOP, EMP, and GMP programs according to relevant up-to-date scientific research/information and according to current regulatory/third party standards.
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The coordinator processes all benefit enrollment, benefit premium reporting and submission of all benefit eligibility to the third party vendors in a timely manner, meeting established deadlines.
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The coordinator will stay abreast of and disseminate pertinent regulatory and insurance related information in order to promote timely and efficient billing of all inpatient, outpatient, ancillary services, and physician billing as well as building and maintaining relationships with key third party resources to maximize the negotiated results and optimize payor revenue growth.
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The CSI Clinical Analyst is knowledgeable regarding changes in care delivery and their impact on third party reimbursement. Preferred experience: Knowledge of hospital reimbursement, third party billing, government rules and regulations.
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Be a Subject Matter Expert / spearhead special projects in Third Party Management and manage cross coordination for additional key controls such as: Training, Models, Records Management, Enterprise Entitlement Review System, Surveillance and Mandatory Absence, EUCs, Loss Capture System, Shared Drives Initiatives etc.
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Provides risk management expertise on behalf of Central Operations while working with Division Risk Managers and other 2nd line risk partners (to include Operational and Enterprise Risk Management teams, Regulatory Compliance, Business Continuity, IT Risk, Third Party Risk, Corp. Security, etc.
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The Care Coordinator will also act as an advocate for the patient physician and hospital relative to compliance with federal state and third party utilization management regulatory requirements.
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Oversee T+1 Trade, Position & Variation Margin reconciliation for all futures and options exchanges, including third-party clearing brokers, ensuring accurate and timely processing. Ensure compliance with regulatory requirements set by SEC, Client, NFA, CFTC, and other applicable exchanges.
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Stay up-to-date with industry best practices and regulatory requirements related to third-party risk and customer data protection. Develop and maintain documentation related to third-party risk management and customer security responses.
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Acts as a liaison between AlloSource third-party vendors, CRO’s, labs, and IRB’s. Oversee preparation of Institutional Review Board (IRB) submissions and EC submissions, notification of regulatory authorities, translation of study related documentation, and communication to research study sites.
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Exposure and experience with Governance Risk and Compliance principles and processes, including foundational data models (entity structure), risk frameworks, regulatory/industry frameworks, control frameworks, controls assessments, policies and procedures, cyber security/information technology risk management processes, third party risk management processes, controls management processes, issues and exception management.
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Examples include but are not limited to: processing monthly charge offs, forwarding accounts to Collection Attorneys and Collection Agencies, Reporting of Negative Share write-offs, Answering disputes on Credit Bureaus, processing court/third party orders that come in for Garnishment/Levies/Child support, Collateral Protection Insurance (CPI) tracking, Account Adjustments, etc.
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Lead implementation of a comprehensive third party risk management program. Demonstrated experience and thorough understanding of various regulatory requirements and laws such as GDPR, SOX as well as risk, control, and assurance frameworks, such as SOC2, ISO, NIST, etc.
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Experience with participation and preparation of BRC third party auditing standards. Experience in laboratory, food safety, food manufacturing, auditing, regulatory or related field.
$76,000 - $86,000 a yearFull-timeExpandApply NowActive JobUpdated 3 days ago
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