Regulatory Compliance Project Specialist

HealthOne Alliance; Dalton (GA); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

401K (Match)

Health Insurance

Dental Insurance

Vision Insurance

Paid Time Off

Short/Long Term Disability

Job summary

HealthOne Alliance is seeking a Regulatory Compliance Project Specialist to compile, review, and submit documentation for audits and regulatory reviews. The role supports quality assurance and privacy efforts, reporting to the Director of Quality Assurance.

Ideal candidates have experience in healthcare or health insurance, strong knowledge of federal/state regulations, and proficiency with document systems and office software.

Qualifications

• Associate degree or equivalent is required.
• 3–5 years healthcare or health insurance experience.
• Knowledge of federal and state regulations for the insurance industry.
• Experience with claim and utilization management processes.
• Preferred experience in health insurance or related field.
• Proficiency with Word, Excel, and Adobe Pro.

Responsibilities

• Maintain knowledge of federal and state regulations and reporting deadlines.
• Review and develop project plans for regulatory audits or reviews.
• Navigate and extract information from claims processing, enrollment, billing systems.
• Compile, review, and submit documents for regulatory requests.
• Develop and monitor corrective action plans as needed.
• Update and communicate compliance policies across departments.
• Support annual regulatory filings and audits as assigned by Director.
• Provide QA/administrative support for the Compliance function.
• Maintain regular attendance and HIPAA compliance.
• Support company culture and organizational values.

Education

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

Tools

Microsoft Word

Microsoft Excel

Adobe Pro

Job description

MISSION

Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of neighbors helping neighbors.

VALUES

HealthOne is guided by a cultural framework that embodies our values and drives our decisions.

Our PURPOSE is to care for people by connecting them to resources that help protect them in health related situations. To fulfill our purpose, we align our PRIORITIES to ensure each decision we make is ethical, empathetic, economical, and efficient. We care for PEOPLE by being welcoming, authentic, truthful, consistent, and humble. We are continuously looking for ways to improve our PROCESS and how we get things done.

HealthOne seeks individuals with integrity and heart to embody our values. Whether you’re starting your career or looking to develop additional skills to reach your full potential, HealthOne provides the means to help you achieve your goals.

JOB PURPOSE

The Regulatory Compliance Project Specialist is responsible for compiling, reviewing, and submitting documentation to support and respond to audits and reviews initiated by both state and federal regulators. This position oversees, monitors, and assists with quality assurance and related compliance functions to ensure timely response to annual regulatory data submissions as well as Market Conduct Examinations and CMS Compliance Reviews. Reporting to the Director of Quality Assurance and Privacy Officer, this position may be responsible to provide administrative, analytical, and technical support for the Quality Assurance Department.

ESSENTIAL JOB DUTIES

• 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

QUALIFICATIONS

• 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

PHYSICAL REQUIREMENTS

Prolonged periods of sitting at a desk and working on a computer. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day responsibilities. Must be able to drive a vehicle and daytime/overnight travel as required.

BENEFITS

• 401K (4% Match, Immediate Vesting)
• Accident insurance
• Competitive salary
• Critical Illness Insurance
• Dental Insurance
• Employee Assistance Program
• Flexible Spending Account
• Health & Wellness Program
• Health Savings Account
• Life & AD&D Insurance
• Long Term Disability
• Medical Insurance
• Paid Time Off
• Pet Insurance
• Short Term Disability
• Vision Insurance

PRE-EMPLOYMENT SCREENING

Drug Screen and Background Check Required

HEALTHONE IS AN EQUAL OPPORTUNITY EMPLOYER

All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, disability, sex, age, ethnic or national origin, marital status, sexual orientation, gender identity or presentation, pregnancy, genetics, veteran status, or any other status protected by state or federal law.