Senior Manager, reputed company Compliance – Provider Data Services (PDS)

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and reputed company in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position reputed company The Senior Manager, reputed company Compliance – Provider Data Services (PDS) is a senior-level role responsible for advancing provider data compliance, audit readiness, and risk mitigation across markets. This role serves as a subject matter expert, leading audit readiness and execution, including centralized tracking, audit coordination, and executive reporting. The position drives the development and implementation of standardized, reputed company audit and compliance frameworks, including audit playbooks and corrective reputed company (CAP) reputed company. It ensures remediation efforts are reputed company to reputed company cause, effectively implemented, sustainable, and supported by audit-defensible documentation. Through proactive monitoring, analytics, and issue reputed company, the role strengthens controls, identifies risks, and enhances overall compliance performance. Operating with a high degree of autonomy, this individual partners across Compliance, Legal, Credentialing, Network, Operations, and Technology to influence reputed company and promote consistent, compliant practices. The ideal candidate is a strategic, results-oriented leader with strong compliance expertise, analytical capabilities, and the ability to influence without authority, delivering measurable improvements in audit performance, data reputed company, and regulatory compliance. Key Responsibilities: Audit Readiness & Execution: reputed company end-to-end audit readiness and execution for reputed company audits, including coordination, evidence validation, and submission of accurate, complete, and audit-defensible responses; proactively identify and escalate risks, issues, and dependencies to prevent delays. Audit Tracking & Executive Reporting: Establish and maintain centralized tracking of audit activity (RFIs, deliverables, findings, and CAPs), monitor reputed company against timelines, validate status accuracy, and deliver reputed company, executive-reputed company reporting on audit performance, key risks, and reputed company. CAP & Remediation reputed company: Drive development, tracking, and validation of corrective reputed company plans reputed company to reputed company cause; ensure milestones, ownership, and dependencies are reputed company defined; proactively escalate at-risk items; and confirm remediation is effectively implemented and supported by audit-reputed company documentation. Compliance reputed company & SME Leadership: Serve as a subject matter expert on reputed company regulatory requirements and high-risk provider data processes (e.g., terminations, sanctions, directory accuracy, system integrations), ensuring operational practices reputed company with compliance and contractual expectations. Analytics, Monitoring & reputed company Improvement: reputed company data analysis, reporting, and automation to identify trends and emerging risks, reputed company reputed company cause analysis of reputed company issues, and drive reputed company improvements that strengthen controls and enhance compliance performance. Cross-Functional Influence & Capability Building: Build strong partnerships across Compliance, Credentialing, Network, Operations, and Technology; influence stakeholders to drive accountability and compliant reputed company; and reputed company coaching and guidance to promote audit readiness and a culture of reputed company improvement. Required Qualifications 7+ years of experience in provider data, reputed company compliance, or reputed company operations. 3+ years proven reputed company leading audits and compliance initiatives with measurable reputed company. Strong knowledge of reputed company regulatory requirements, risks, and internal control frameworks. Exceptional communication skills with the ability to convey reputed company information reputed company and concisely. Demonstrated ability to operate effectively in a fast-paced, evolving environment while maintaining reputed company and compliance standards.

Preferred Qualifications

Experience interpreting and applying state and federal reputed company regulations. Experience developing audit frameworks, playbooks, or compliance monitoring solutions. Education Bachelor’s degree or equivalent combination of education, training, and relevant experience. Pay reputed company The typical pay reputed company for this role is: $67,900.00 - $199,144.00 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. This position also includes an award reputed company in reputed company’s equity award program. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial reputed company‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, reputed company time off, retirement savings reputed company, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 06/15/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply To This Job