Healthcare Compliance Analyst: CMS & FWA Oversight

Imperial Health Plan of California, Inc.; Pasadena (CA); On-site; USD 80,000 - 105,000; Full time

Job summary

Imperial Health Plan of California, Inc. seeks a Compliance Analyst to coordinate oversight activities across Imperial and FDRs to meet CMS requirements for preventing, detecting, and correcting Fraud, Waste and Abuse.

The role involves reporting compliance activities, interpreting regulations, conducting training, audits, CMS submissions, and coordination with internal teams to ensure policy adherence 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.
• 2 years of healthcare compliance experience or, in lieu thereof, two years working with a CMS government program or state regulatory agency.
• 2 years of experience with regulatory requirements.
• Audit experience preferred.

Responsibilities

• 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 appropriate action is taken.
• 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.
• Perform audits of operational areas and FDRs to determine CMS compliance.

Skills

Strong computer skills

CMS knowledge

Independent work

Communication skills

Meet deadlines

Confidentiality

English proficiency

Multitasking

Education

Bachelor's degree preferred

Tools

Word processing

Spreadsheets

Databases

Job description

Imperial Health Plan of California, Inc. seeks a Compliance Analyst to coordinate oversight activities across Imperial and FDRs to meet CMS requirements for preventing, detecting, and correcting Fraud, Waste and Abuse.

The role involves reporting compliance activities, interpreting regulations, conducting training, audits, CMS submissions, and coordination with internal teams to ensure policy adherence and HIPAA compliance.