- Position: Compliance Analyst
- Employment Type: Full-Time
- Location: Allentown PA
Ideal Concepts, Inc. is looking for an experienced Compliance Analyst to clarify, monitor, and research various compliance policies and procedures.
Responsibilities and Duties
- Acting as a regulatory resource to clarify, monitor, and research regulatory requirements, provides proactive compliance monitoring and assessments with regards to key initiatives and increasing compliance requirements, collaborates with other departments and business partners to manage corrective action processes when needed, and supports CMS audits.
- Assisting with the development, update, revision, and/or implementation of policies, procedures and practices for the general compliance and operations.
- Researching and analyzing of matters related to existing and new regulatory requirements as well as assisting with Medicaid regulations as needed.
- Coordinating with other departments to gather information needed for regulatory reviews, validations, and audits.
- Assisting with the compliance oversight of First Tier, Downstream, and Related Entity (FDR) requirements including exclusion screening, distribution of Code and Standards of Conduct, compliance with all applicable training requirements, monitoring and auditing of downstream entities, appropriate reporting mechanisms for fraud, waste and abuse and compliance issues, and HIPAA Privacy controls.
- Assisting with the investigation, auditing, review and analysis of general compliance, HIPAA Privacy, and other matters to ensure compliance with governmental regulations and internal policies.
- Helping identify areas for audit opportunities based on industry performance, regulatory focus areas and risk areas within the organization. Must demonstrate strong critical thinking and analytical skills when performing various audits.
- Establishing and maintaining open lines of communication, both internal and external, to effectively present department services, policies, procedures and programs.
- Drafting and submitting responses to external inquiries and requests.
- Producing accurate and concise work products that require no more than minor revisions.
- Managing multiple tasks simultaneously ensuring timely execution in a fast-paced environment.
- Demonstrating the ability to work effectively within multidisciplinary teams.
Qualifications and Skills:
- A Bachelor’s degree is required. Business Administration, Healthcare Compliance, legal/paralegal, or related preferred.
- Experience in compliance, audit, or other risk management working experience in health insurance industry, managed care and government programs, health insurance compliance programs, or related fields. Experience with Medicare Advantage/Part D and Qualified Health Plan programs preferred.
- The ability to read and interpret insurance laws, regulations, and policies is a must.
- The successful candidate will possess strong organizational, coordination skills and interpersonal skills for facilitating Compliance audits, the ability to gather and analyze data and generate reports.
- Excellent communication skills (written and verbal).
- Strong analytical skills required.
- Must be a self-starter, results-oriented, a team player and be able to prioritize responsibilities.