Compliance Analyst II – Healthcare Experience Required
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Job Description
Compliance Analyst II supporting CareSource's Compliance Program by overseeing high risk areas. Collaborating with business owners to ensure effective implementation of compliance regulations.
Responsibilities:
- Provide analysis, interpretation, training, and education related to requirements as needed to ensure understanding and effective implementation of compliance requirements
- Support departments with requirement implementation, reporting development, policy and procedure development/review, and readiness testing
- Collaborate with internal business owners to ensure implementation of the health plan’s business and contractual requirements
- Work with Compliance leadership to interpret regulations and provide related guidance
- Assist in review and dissemination to team of Regulatory Distribution Management items (new and changing regulations)
- Provide Compliance Program support with audit and monitoring, corrective action plan management, data analytics and other projects
- Analyze relevant business and/or delegate/FDR performance data to ensure compliance with requirements and prepare reports for leadership and business owners
- Proactively use analytic and research skills to identify potential areas of risk
- Support and/or coordinate audit activities with impacted business owners to ensure adequate representation from subject matter experts (SME) for external reviews and audits
- Proactively maintain documentation, data universes, responses and other written or electronic materials using the proper compliance tools and in accordance with Corporate Compliance protocols
- Investigate risks and issues with effective research, root cause analysis, and gap analysis for effective remediation and corrective action management
- Build and maintain positive and strategic relationships with internal and external stakeholders
- Attend all required implementation meetings and communicate outcomes, manage deliverables, and provide guidance to business areas
Requirements:
- Bachelor’s degree in business or related field, or equivalent years of relevant work experience is required
- Minimum of three (3) years of compliance and/or regulatory experience including one (1) year in Government Program products is required
- Strong familiarity with government-funded healthcare programs, including Medicaid
- Familiarity with Healthcare operations and/or clinical concepts, practices and procedures is preferred
- Data analysis ability to produce meaningful insight and drive appropriate action
- Demonstrated understanding of Compliance and Regulatory fundamentals specifically related to managed care and government programs (CMS/HHS/DOI/Medicaid)
- Ability to conduct research and analysis of Federal, State, and relevant industry regulatory and enforcement
- Proven ability to effectively manage work through prioritization, preparing, effective scheduling, leveraging resources and maintaining focus
- Demonstrated professional communication skills, to include proper grammar usage, document structure, and business writing to audiences
- Advanced organizational, project management and scheduling skills
- Strong decision making and problem-solving skills
- Ability to work independently and within a team environment
- Demonstrated success in working in a matrixed environment
- Detail oriented with focus on maintaining accurate information in tools as required
- Demonstrated critical thinking skills
- Negotiation skills/experience
- Time management skills including creation and maintenance of project timelines
- Advanced level experience in Microsoft Word, Excel and PowerPoint
Benefits:
- Health insurance
- 401(k) matching
- Flexible work hours
- Paid time off
- Professional development opportunities
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