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Company

CareSource · 5 hours ago

REMOTE - Compliance Analyst II (Medicare/PACE) - R8280

United States

Full-time

Remote

Mid Level

$69K/yr - $111K/yr

3+ years exp

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Comp. & Benefits

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Responsibilities

Provide analysis, interpretation, training, and education related to requirements as needed to ensure understanding and effective implementation of compliance requirements

Support departments with requirement implementation, reporting development, policy and procedure development/review, and readiness testing

Collaborate with internal business owners to ensure implementation of the health plan’s business and contractual requirements

Work with Compliance leadership to interpret regulations and provide related guidance

Assists in review and dissemination to team of Regulatory Distribution Management items (new and changing regulations); works to understand and provide expertise to team on these items and the impact to our work with high-risk business areas

Provide Compliance Program support with audit and monitoring, corrective action plan management, data analytics and other projects to ensure proper execution of the Compliance Program workplan and priorities

Analyze relevant business and/or delegate/FDR performance data to ensure compliance with requirements and prepare reports for leadership and business owners

Proactively use analytic and research skills to identify potential areas of risk to CareSource and make recommendations or escalate to Compliance Management for issue management, external audit enforcement trending, and related industry corrective actions

Support and/or coordinate audit activities with impacted business owners to ensure adequate representation from subject matter experts (SME) for external reviews and audits

Proactively maintain documentation, data universes, responses and other written or electronic materials using the proper compliance tools and in accordance with Corporate Compliance protocols

Investigate risks and issues with effective research, root cause analysis, and gap analysis for effective remediation and corrective action management

Ensure timely, complete, accurate, and concise documentation of corrective action plans, case summaries and executive summaries for all compliance matters. Documentation must include problem, history, mitigation or corrective actions, and recommendations for ongoing monitoring or process improvement

Build and maintain positive and strategic relationships with internal and external stakeholders

Attend all required state regulator meetings and communicate outcomes, manage deliverables, and provide guidance to business areas

Perform any other job duties as requested

Qualification

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Compliance Program ManagementData AnalysisRegulatory ComplianceMedicare ExperienceHealthcare OperationsAudit FunctionsProject ManagementCertified in Healthcare Compliance (CHC)Microsoft WordMicrosoft ExcelMicrosoft PowerPoint

Required

Bachelor’s degree in business or related field, or equivalent years of relevant work experience is required

Minimum of three (3) years of compliance and/or regulatory experience including one (1) year in Government Program products is required

Strong familiarity with government-funded healthcare programs, including Medicaid, Marketplace, and Medicare, and the compliance standards imposed upon First Tier, Downstream and Related (FDR) entities

Data analysis ability to produce meaningful insight and drive appropriate action

Demonstrated understanding of Compliance and Regulatory fundamentals specifically related to managed care and government programs (CMS/HHS/DOI/Medicaid)

Proven knowledge of internal and external audit functions and procedures

Ability to conduct research and analysis of Federal, State, and relevant industry regulatory and enforcement

Proven ability to effectively manage work through prioritization, preparing, effective scheduling, leveraging resources and maintaining focus

Demonstrated professional communication skills, to include proper grammar usage, document structure, and business writing to audiences including but not limited to internal Leadership at all levels, internal and external Legal Counsel, Corporate Compliance, State and Federal Regulators

Advanced organizational, project management and scheduling skills

Strong decision making and problem-solving skills

Ability to work independently and within a team environment

Demonstrated success in working in a matrixed environment

Detail orientated with focus on maintaining accurate information in tools as required

Demonstrated critical thinking skills

Time management skills including creation and maintenance of project timelines

Advanced level experience in Microsoft Word, Excel and PowerPoint

Preferred

Medicare experience is highly preferred

PACE experience is highly preferred

Familiarity with Healthcare operations and/or clinical concepts, practices and procedures is preferred

Certified in Healthcare Compliance (CHC) or Certified Compliance and Ethics Professional (CCEP) preferred

Current, unrestricted clinical licensure to include: LPN in state of service, Registered Nurse (RN) in the state of service, or other clinical licensure may be desired for positions with a clinical focus

Functional business licensure/ certification may be desired as they apply to organizational operations (e.g. Claims coding certification, analytics certification, etc.)