Compliance Analyst

ADP, Inc.; Pasadena (CA); On-site; USD 71,000 - 78,000; Full time

Job summary

Imperial Health Plan in Pasadena, CA seeks a Compliance Analyst to oversee CMS regulatory compliance, FWA prevention, and audits across the organization and FDRs. This role coordinates internal monitoring, training, and reporting to compliance committees.

You will review CMS and state requirements, perform CMS data checks, and help prepare site visit materials while maintaining confidentiality and HIPAA compliance.

Qualifications

• Bachelor's degree preferred and/or 3 to 5 years of related work experience in a health plan and/or healthcare setting.
• Required: 2 years of healthcare compliance experience or CMS/state regulatory agency experience.
• Required: 2 years of experience with regulatory requirements.
• High school graduate or equivalent.

Responsibilities

• Coordinate the compliance oversight activities to meet CMS requirements.
• Report to compliance committees and external oversight entities.
• Review regulatory communications and implement changes as needed.
• Perform internal monitoring and audits of CMS program requirements.
• Prepare CMS and state reporting submissions.
• Assist regulatory site visits and reviews.

Skills

CMS knowledge

Regulatory knowledge

Communication skills

Independent work

Education

Bachelor's degree preferred

High school diploma or equivalent

Tools

MS Office

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Compliance Analyst

Salary Range: $71,000.00 To $78,000.00 Annually

JOB DESCRIPTION

JOB TITLE: Compliance Analyst
FLSA STATUS: Exempt
DEPARTMENT: Compliance
REPORTS TO: Compliance Officer

JOB SUMMARY

Will coordinate the compliance oversight activities for Imperial and with first-tier, downstream, and related entities (FDRs), as necessary, to meet the contractual oversight regulatory requirements for the prevention, detection, and correction of Fraud, Waste and Abuse (FWA) and Medicare program non-compliance as established by the Centers for Medicare and Medicaid Services (CMS).

ESSENTIAL JOB FUNCTIONS

Support the accurate and complete reporting of compliance activities to the compliance committees and external oversight entities.

Review and interpret all regulatory communications applicable to the organization and FDRs and ensure that appropriate action is taken, including dissemination to applicable areas and implementation of changes as needed.

Perform and assess the effectiveness of regulatory compliance training and education activities applicable to the Exchange line of business and other regulatory requirements.

Coordinate and perform ongoing internal monitoring of activities, including tracking compliance and implementing appropriate action as required.

Perform audits of operational areas and FDRs, whether desk or off-site, in accordance with the annual workplan or through ad hoc audits to determine compliance with CMS operational and Compliance Program requirements, including validation of data and internal controls.

Review and submit comments, when necessary, for all assigned internal marketing reviews prior to their submission to CMS for approval.

Participate in CMS webinars, seminars, and conference calls applicable to assigned responsibilities.

Be responsible for the issuance and management of compliance actions due to non-compliance resulting from reported issues, monitoring, and auditing activities.

Coordinate the timely and accurate completion of CMS and state reporting requirements and other required submissions.

Perform appropriate CMS data submission quality checks and update developed tools as necessary.

Monitor, analyze, and communicate CMS analyses and other reports related to compliance.

Investigate and respond to reported issues and incidents of potential non-compliant or FWA activities.

Coordinate with internal departments and FDRs on issues related to compliance and FWA.

Coordinate and assist the Compliance Department in preparation activities for regulatory site visits and reviews.

Coordinate with other members of the Compliance Department or throughout the organization when assigned activities overlap or as directed by Management.

For FDRs, perform pre-contract reviews, designation of prospective FDR contracts, and pre-assessments to ensure prospective entities have policies, operations and staff to fulfill the proposed contracted activities of the plan.

For FDRs, communicate information regarding Imperial Health Plan's Compliance Program and monitor their adherence to requirements.

Be responsible for supporting the implementation of the seven elements of a compliance program and FDR oversight.

Maintain regular and consistent attendance.

Adhere to the Compliance Plan and HIPAA regulations.

MARGINAL JOB FUNCTIONS

Take on special projects as needed.

Perform other duties as assigned.

BEHAVIORAL EXPECTATIONS

Attend staff meetings as required.

Attend appropriate training, seminars, and workshops as required.

Customer Focus

Maintain client/customer confidentiality and privacy in accordance with HIPAA regulations and Imperial's Standards of Conduct.

Foster appropriate communication and relations with supervisors, co-workers, and other staff.

Quality/Process Improvement/Safety

Report issues of security, health, and/or safety to the appropriate supervisor as soon as practicable.

Support and demonstrate safety throughout all duties performed.

Follow established policies and procedures and understand and comply with all regulatory standards set forth by governing entities.

POSITION REQUIREMENTS

EDUCATION/EXPERIENCE

High school graduate or equivalent.

Bachelor's degree preferred and/or 3 to 5 years of related work experience in a health plan and/or healthcare setting.

Required: 2 years of healthcare compliance experience or, in lieu thereof, two years working with a CMS government program or state regulatory agency.

Required: 2 years of experience with regulatory requirements.

SKILLS/KNOWLEDGE/ABILITY

Strong computer skills, including proficiency in word processing, spreadsheets, and databases.

Knowledge of CMS and state regulatory guidelines related to job functionality.

Ability to work independently.

Strong communication and interpersonal skills.

Ability to meet deadlines.

Ability to maintain an appropriate level of confidentiality and privacy.

Willingness and ability to read, write, speak, and understand English and have the communication skills necessary to provide accurate information to members and staff.

Willingness and ability to follow written and verbal direction in English.

Willingness and ability to maintain an appropriate level of confidentiality and privacy.

Willingness and ability to interact professionally with all customers, members, and co-workers, individually and as part of a team.

Willingness and ability to effectively handle multiple items/tasks as required and adapt favorably to changing priorities.

Willingness and ability to make appropriate judgments, decisions, and problem solving in a timely manner and within the context of the situation at hand.

Ability to effectively prioritize items/tasks as required.

Willingness and ability to take initiative and be a self-starter.

Willingness and ability to understand and comply with federal, state, and local regulations.

LICENSURE/CERTIFICATE/TRAINING

Certified in Healthcare Compliance (CHC) preferred.