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Compliance Analyst

The Compliance Analyst will serve as a role model for ethical behavior while supporting the company in ensuring compliance with laws, rules, regulations and policies that govern the company’s business. The Compliance Analyst will be responsible for the coordination and completion of all government, regulatory, and compliance documents for all business units.

PRINCIPAL RESPONSIBILITIES

• Assists the director in the implementation of compliance programs, policies and procedures designed to ensure compliance with all applicable federal laws and Medicare Advantage and Prescription Drug Plan (MA-PD) regulations.
• Maintain and update department policies and procedures as necessary to reflect changes in federal and state laws and regulations.
• Participate in the compliance review and approval process of marketing material and required annual mailings (i.e. ANOC/EOC, Summary of Benefits, and Provider Directory).
• Coordinates internal and external audits ensuring timely submissions for audit requests, monitoring compliance with standards and tracking corrective action plans to completion.
• Oversee Medicare Part C & D Reporting Requirements, including CMS Data Validation Audit process.
• Review and interpret HPMS memo and summary guidance, ensuring regulatory requirements are tracked and documented through completion.
• Assists and supports compliance-related projects and initiatives, participating collaboratively in staff meetings, committees, projects and teams to resolve issues and meeting compliance program goals.

POSITION REQUIREMENTS

• Thorough knowledge of CMS guidelines, process and systems
• Demonstrated knowledge of regulatory compliance policies and procedures in a managed care environment.
• Solid knowledge of Microsoft Office (Excel, Word, PowerPoint)
• Bachelor’s Degree or equivalent related experience
• At least 4 years’ experience in Medicare Advantage or Managed Care industry
• Ability to handle multiple projects and competing priorities
• Strong written, verbal, listening and communication skills – having the ability to understand and communicate appropriately to the targeted audience
• Strong analytical skills – having the ability to identify an issue, conduct an analysis to determine business impact (including gap analyses) and identify solutions
• Strong project management skills - having the ability to effectively manage multiple priorities simultaneously by maintaining established timeframes, adhering to work plans and communicating changes effectively
• Ability to work independently and with a team


Physical Requirements

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

Physical Demands:

• Must be able to frequently sit, use finger dexterity, has good vision, hearing, and speaking to promote information exchange.
• Must be able to stand and use a copier, collate, staple, and bind large packets for meetings.
• Occasionally may have to lift boxes of office supplies and stack reams of paper on high shelves.

Mental Demands:

• Must be able to frequently problem solve, make decisions, interpret data, organize and analyze work flow, write, plan, and use simple arithmetic.

Working Conditions:
• Work is conducted indoors.
• Requires sitting at a desk in an office settings.

Major activities of the job include:

• Must be able to operate general office equipment including but not limited to: computer, phones, and related media and information devices.

Communication requirement:

• Must have the ability to communicate in writing, speaking, and hearing, both in person and/or by telephone.


This job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designated to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job.

Management retains the right to add or change the duties of the positions at any time with or without notice.

Time:  Full time
Salary:  Salary
Category:  Compliance

Updated: 8/16/2018 4:36:36 PM