Healthcare Compliance Analyst: CMS & FWA Oversight

Imperial Health Plan of California, Inc.; Pasadena (CA); Vor Ort; USD 85.000 - 110.000; Vollzeit

Zusammenfassung

Imperial Health Plan of California, Inc. is seeking a Compliance Analyst in Pasadena, CA, to coordinate oversight activities with Imperial and related entities per CMS requirements for FWA prevention and Medicare program compliance.

The role reports to the Compliance Officer and requires collaboration with the Compliance Department on seven elements of a compliance program, CMS data submissions, and internal audits. A strong background in healthcare regulations and audit practice is expected.

Qualifikationen

• High school graduate or equivalent.
• Bachelor's degree preferred; 3–5 years in health plan/healthcare setting.
• 2 years healthcare compliance experience or CMS/state regulatory agency experience.
• 2 years of experience with regulatory requirements.
• Audit experience preferred.

Aufgaben

• Support accurate and complete reporting of compliance activities to the compliance committees and external oversight entities.
• Review regulatory communications applicable to the organization and FDRs and ensure appropriate action is taken.
• Perform and assess effectiveness of regulatory compliance training and education activities.
• Coordinate and perform ongoing internal monitoring of activities, including tracking compliance and implementing action as required.
• Perform audits of operational areas and FDRs to determine CMS compliance and internal controls.
• Review and submit comments for internal marketing reviews prior to CMS approval.
• Participate in CMS webinars, seminars, and conference calls relevant to responsibilities.
• Coordinate timely completion of CMS and state reporting requirements and other submissions.
• CMS data submission quality checks and update tools as necessary.
• Monitor and communicate CMS analyses and other compliance reports.
• Investigate and respond to potential non-compliant or FWA activity.

Kenntnisse

CMS regulations

Healthcare compliance

Regulatory requirements

Auditing

Communication skills

Data privacy

Ausbildung

Bachelor's degree preferred

High school graduate or equivalent

Jobbeschreibung

Imperial Health Plan of California, Inc. is seeking a Compliance Analyst in Pasadena, CA, to coordinate oversight activities with Imperial and related entities per CMS requirements for FWA prevention and Medicare program compliance.

The role reports to the Compliance Officer and requires collaboration with the Compliance Department on seven elements of a compliance program, CMS data submissions, and internal audits. A strong background in healthcare regulations and audit practice is expected.