Job description

HEALTHCARE COMPLIANCE ANALYST - Hybrid

JOB SUMMARY

This role is to act as liaison with Health Plan representatives to assure that communications and updates related to regulatory and operational issues are successfully distributed and acted upon within the organization. The position is responsible for updating the client through regular written communication and attendance at board meetings on the status of Health Plan requests within the organization. This position works closely with operations, clients and Health Plan representatives.

POSITION PURPOSE

To assist in the coordination and execution of internal compliance and ethics, regulatory compliance, and dissemination of CMS Memorandums. To support the corporate compliance plan through direction of the Chief Compliance Officer and to be an additional resource to internal departments for research and educational purposes.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Manage the process for review, update, maintenance, and approval of corporate policies and departmental procedures.
• Support Management in coordination of Compliance committee meetings, including taking minutes.
• Perform light auditing and monitoring activities under the direction of Management.
• Coordinate and complete the annual FDR attestation process.
• Upload documents into the CMS HPMS system as appropriate.
• Track completion of company wide compliance training; escalate issues of non-compliance to Management.
• Provide Administrative support to the Compliance Department.
• Perform other duties as assigned.

Qualifications

EDUCATION / EXPERIENCE

• ∙ Bachelor's degree in business, healthcare or related field. Or, a combination of relevant Medicare Advantage experience plus education in lieu of Bachelor’s degree.
• ∙ Minimum 3-5 years of experience in a managed care organization, preferably in compliance at a government-sponsored health plan (Medicare/Medicaid).
• Experience in researching and analyzing state and federal law and regulations.
• Comprehensive understanding of Medicare and/or Medicaid.
• Strong interpersonal and excellent written, verbal communications, and analytical skills.
• Intermediate knowledge of Microsoft Office (Excel, Word, PowerPoint, Teams, etc.).
• Takes initiative and follow-through on projects with minimal supervision or guidance.
• ∙ Experience working with health plans and regulatory agencies.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

∙ Must be able to work in sitting position, use computer and answer telephone.

∙ Ability to travel locally.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

∙ Office Work Environment.

OTHER

∙ Approximately 30 - 50% local travel may be required.

Job Type: Full-time

Pay: $50,000.00 - $70,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Education:

• Bachelor's (Preferred)

Experience:

• Medicare/Medicaid: 3 years (Required)
• Managed Care: 3 years (Required)

Willingness to travel:

• 25% (Preferred)

Work Location: One location

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