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Position Details

  • 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. This position is key to ensuring our agents’ compliance with company policies, carrier requirements, CMS regulations, and all other applicable federal and state laws. The Ideal person will need to have excellent communication skills, very strong follow up and documentation practices, and possess proven analytical skills with the ability to work consistently within established timelines and promote our company’s goal of overall compliance.

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 insurance 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.
  • Proven ability to handle multiple projects simultaneously and adjust to changes quickly while meeting deadlines.
  • Demonstrating the ability to work effectively within multidisciplinary teams.

Qualifications and Skills:

  • 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.
  • Bachelor’s Degree with a minimum GPA of 3.0 in Healthcare Compliance, legal/paralegal, or related 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.

 Benefits

  • 15 PTO days
  • 8 paid pre-determined holidays
  • Employee 401k Plan
  • Fully covered health benefits (100% company contribution), including major medical, dental, vision, and life insurance
  • Technology focused, fast paced working environment
  • Professional team atmosphere with motivated, career-driven professionals as co-workers
  • Expansion and growth with one of the top health insurance marketing companies in the nation
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