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Job Summary
The Compliance Analyst II position is a professional compliance role responsible for supporting the Compliance Program by collaborating and overseeing high risk areas to ensure that the compliance program is effective and efficient in identifying, preventing, detecting, and correcting noncompliance.
Essential FunctionsCompliance Prevention:
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
Compliance Detection
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
Compliance Correction
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 identified risks.
Account Relationship
Build and maintain positive and strategic relationships with internal and external stakeholders
Attend all required implementation meetings and communicate outcomes, implementation meetings, manage deliverables, and provide guidance to business areas
Perform any other job duties as requested
Education And Experience
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
Competencies, Knowledge And Skills
Strong familiarity with government-funded healthcare programs, including Medicaid, , and the compliance standards imposed upon First Tier, Downstream and Related (FDR) entities
Familiarity with Healthcare operations and/or clinical concepts, practices and procedures is preferred
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)
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
Negotiation skills/experience
Time management skills including creation and maintenance of project timelines
