Regulatory Compliance Project Lead

Health One Alliance, LLC; Dalton (GA); Presencial; USD 60.000 - 90.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

401K contribution 4% matching

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Short/Long Term Disability

Paid Time Off

Flexible Spending Account

Employee Assistance Program

Wellness Program

Descripción de la vacante

HealthOne seeks a Regulatory Compliance Project Specialist to compile, review, and submit documentation for audits by state and federal regulators. This role oversees quality assurance and compliance functions, ensuring timely regulatory submissions and responses to Market Conduct Examinations and CMS reviews.

Reports to the Director of Quality Assurance and Privacy Officer. The position provides admin, analytical, and technical support to the Quality Assurance Department and requires

Formación

• Associate degree or equivalent.
• Three to five years' healthcare or health insurance experience.
• Working knowledge of federal and state regulations for the insurance industry.
• Working knowledge of claim and utilization management processes.
• Preferred experience in health insurance or related field.
• Competency with Microsoft Word and Excel as well as Adobe Pro programs.

Responsabilidades

• Maintain a working knowledge of federal and state regulations, reporting deadlines, and documentation requirements.
• Collaborate with Director to review and develop a project plan for managing and responding to a regulatory audit or review.
• Proficient in navigation and information mining from systems used in company operations such as; claims processing, enrollment and billing, utilization management, and call center operation.
• Compile, review, and submit accurate and timely documentation in response to regulatory audit requests.
• Develop and monitor corrective action plans as may be required.
• Assist in establishing, updating, and communicating new and existing compliance policies and procedures for internal departments based on regulatory audit results.
• Monitor, plan and compile documentation for annual regulatory filings assigned by the Director.
• Provide administrative, analytical, and technical support for the Quality Assurance Department as needed in relation to regulatory compliance.
• Maintains regular and predictable attendance.
• Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice.
• Works to encourage and promote Company culture throughout the organization.
• Other duties as may be assigned.

Conocimientos

Regulatory compliance

Analytical skills

Attention to detail

Communication

Educación

Associate degree or equivalent

Herramientas

Microsoft Word

Excel

Adobe Pro

Descripción del empleo

HealthOne seeks a Regulatory Compliance Project Specialist to compile, review, and submit documentation for audits by state and federal regulators. This role oversees quality assurance and compliance functions, ensuring timely regulatory submissions and responses to Market Conduct Examinations and CMS reviews.

Reports to the Director of Quality Assurance and Privacy Officer. The position provides admin, analytical, and technical support to the Quality Assurance Department and requires