CarePlus Health Plans · 4 days ago
UM Compliance Analyst
Florida, United States
Full-time
Remote
Entry Level
$63K/yr - $87K/yr
1+ years exp
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Responsibilities
Conducts and summarizes compliance audits.
Collects and analyzes data daily, weekly, monthly or as needed to assess outcome and operational metrics for the team and individuals.
Reviews and interprets new CMS and regulatory requirements and works with the business area to ensure compliance with requirements.
Manages tasks and timelines to ensure compliance with regulatory initiatives.
Conducts quality assurance audits of pre-service organization determinations to ensure compliance requirements and internal processes are being followed.
Generation and data scrubbing of CMS audit universes including source system validations.
Reviews and validates monthly compliance metrics and works with the business area to identify root cause and implement corrective action plan for any non-compliant metrics.
Works with the business area in updating policies and procedures.
Attends assigned compliance meetings and acts as the liaison between the HSO compliance team and Health Services business areas.
Coordinate special compliance projects and any additional tasks as determined by leadership.
Qualification
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Required
1 or more years of work experience in a compliance, auditing, and/or in a health plan working in the utilization management department.
1 or more years of managing departmental updates, process improvement and/or special projects.
1 or more years of experience with trending and analyzing data.
Comprehensive knowledge of Microsoft Outlook, Word and Excel
Hours: Monday-Friday 8:00 AM-5:00 PM Eastern Time, occasional overtime as needed.
Preferred
Bachelor's Degree
Strong analytical and attention to detail skills.
Certification(s) relevant to compliance area of expertise, such as certification in healthcare compliance (CHC)
Prior Medicare health plan experience
Knowledge of CMS regulations pertaining to compliance in a managed care health plan
Bilingual (English and Spanish)
Benefits
Medical, dental and vision benefits
401(k) retirement savings plan
Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
Short-term and long-term disability
Life insurance
Company
CarePlus Health Plans
CarePlus Health Plans provides medical and health care plans.
501-1,000 employees
Funding
Current Stage
Late StageTotal Funding
unknown2004-12-14Acquired· undefined
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