Regulatory Compliance Analyst Jobs

Senior Regulatory Compliance Analyst

100% Remote C2H remote role

Location : VA/MD / Remote

• Will work alongside legal dept on external comms to make sure info is correct.
• Will be reviewing regulatory updates, writing summaries and calls to action.
• Medicare and Medicaid are focus areas
• Lot of Memos from CMS (updates, upcoming mandates, simple reminders, etc...) so needs to know how to read those memos and interpret them based on what is written and be able to communicate that out to stakeholders.
• Will help to investigate the root cause of incidents as it relates to compliance as well.. Will have to produce action plans and track them.
• Needs to be very good at communicating verbally and written.
• Will accept folks in the pharma world or just has worked for a health plan as long as they have compliance BG if we cannot find Medicare/Medicaid focused individuals
• Looking for someone who has a bach degree (not required if they have the work exp).
• Consistent compliance monitoring.
• Day to day ranges from review/analysis or development and implementation of policy and procedures as it relates to Medicaid/Medicare
• For example: Will be pulling enrollments and reviewing them for timeliness and compliance... Will monitor credentialing as well.
• Needs at least 5 YOE in Compliance.. Medicare/Medicaid is key skillset.

Business Support

Research, resolve and respond to written inquiries forwarded from Congressional, Attorney General and State officials, members, providers, groups and brokers. Coordinate with internal and external parties to ensure accurate information is obtained. Review and analyze provided data and information. Provide detailed professionally written responses to originating party, ensuring all questions are answered and customer needs are effectively served within designated timeframes while ensuring privacy needs of members are respected. Review, analyze, prepare detailed documentation for support of legal action pertaining to ... indemnity business, ensuring that all appropriate materials, related claims, contracts, payment vouchers are included. Develop a summary/assessment of included documentation for legal staff. Meet, discuss, and strategize with legal staff to prepare for depositions, court cases or administrative hearings. Appear as required to testify on behalf of ....

15% System Compliance Analysis

Review moderately complex business processes and systems to identify, document, elevate the presence of risks and trends within systems and processes that may be non-compliant with contracts and or statutory requirements especially in the claims processing, enrollment and service arenas - all jurisdictions, all products, all processing platforms to include our subsidiaries. Actively participate in implementation/corrective workgroups to ensure compliance perspective and concerns are addressed through the process.

15% Litigation and Legal Support

Review, analyze, prepare detailed documentation for support of legal action pertaining to ... indemnity business, ensuring that all appropriate materials, related claims, contracts, payment vouchers are included. Develop a summary/assessment of included documentation for legal staff. Meet, discuss, and strategize with legal staff to prepare for depositions, court cases or administrative hearings. Appear as required to testify on behalf of ...

10% Special Projects

Provide research, investigative and analytic support on special projects ensuring that all ... policies and contractual guidelines are clearly identified. Provide support to supervisors and other internal associates with written responses to inquiries.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable

accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education Level: bachelor’s degree

Experience: 5 years’ experience in a compliance or senior level customer service role.

In Lieu of Education

In lieu of a bachelor’s degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Preferred Qualifications

Knowledge, Skills and Abilities (KSAs)

Skill in using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems., Advanced

Ability to convey information in a clear, concise, and logical manner., Advanced

Ability to effectively convey information to others., Advanced

Excellent critical thinking and communication skills both written and verbal. , Advanced

Consistently maintains highly professional written and verbal interaction with all levels of staff within the company and with members of regulatory agencies., Advanced

Must be able to interpret insurance law and regulations. , Advanced

Additional Skills:

Top 5 Required Skills:

(1) Problem Solving

(2) Communication

(3) Research

(4) Auditing/Monitoring

(5) Organizational