Senior Compliance Analyst

capitalhealth; Tallahassee (FL); On-site; USD 65,000 - 85,000; Full time

Benefits offered by this job

Health coverage

Dental insurance

Short and long-term disability

Paid time off

Job summary

Capital Health Plan in Tallahassee, FL is seeking a full-time Senior Compliance Analyst to ensure compliance with federal, state, and regulatory guidelines. You will analyze, audit, and monitor operational compliance while communicating with internal and external partners.

The ideal candidate holds a bachelor's degree and possesses strong analytical and communication skills. You'll benefit from a full benefits package including health coverage, retirement plans, and paid time off.

Qualifications

• Proven ability to read, analyze, and interpret legal and regulatory materials.
• Working knowledge of federal sentencing guidelines, HIPAA, and privacy laws.
• 4+ years of related experience in a Medicare Advantage and/or commercial-managed care environment is preferred.

Responsibilities

• Ensure compliance with all federal, state, and regulatory laws/guidelines.
• Communicate improvement suggestions clearly to stakeholders.
• Manage annual compliance risk assessment and work plan.

Skills

Analytical mindset

Professional communication

Strong literacy skills

Mathematical skills

Problem-solving skills

Education

Bachelor's degree from a four-year college/university

Tools

Microsoft Word

Microsoft Excel

Job description

Do you pride yourself on being highly analytical, organized, and compliant with all policies? Can you work with internal/external partners to maintain high levels of compliance and accuracy? If so, Capital Health Plan invites you to join our Tallahassee, FL team as a full-time Senior Compliance Analyst!

You'll earn competitive compensation (based on experience/qualifications) and enjoy a full benefits package that includes:

• Health coverage and dental insurance
• Health and dependent care spending accounts
• Short and long-term disability
• Major disability time off (MDTO)
• Retirement plan
• Life and AD&D insurance
• Voluntary life and AD&D insurance
• Paid time off (PTO)
• Employee assistance program
• SmartDollar

Keep reading to see if you're the Senior Compliance Analyst we're looking for.

OUR MISSION

We are a not-for-profit health care organization that has served the panhandle since 1982, delivering high-quality, affordable, and patient-centered care. Our employees are essential to our continued success, and their passion, motivation, and commitment drive our reputation for excellence and member satisfaction. Whether delivering direct care, supporting patients, or ensuring smooth operations behind the scenes, every team member plays a vital role in fulfilling our mission to improve the health of our communities. We are dedicated to fostering a professional, respectful, and inclusive workplace where employees are valued, supported in their growth, and empowered to make a meaningful impact. Join us!

YOUR ROLE AS OUR SENIOR COMPLIANCE ANALYST

You’ll play a very important part on our team by making sure our work activities and documentation meet all federal, state, and regulatory laws/guidelines. Meticulous attention to detail and effective communication skills will be crucial, as you’ll be researching, analyzing, auditing, and monitoring operational compliance functions for compliance with internal and external stakeholders, clearly communicating improvement suggestions when appropriate. You’ll work with internal/external partners to ensure compliance with all CMS, HPMS, and State regulations, perform in-depth reviews to verify accuracy, and meet all deadlines. Prioritizing accuracy and thoroughness, you’ll review and help manage data validation audit activities/submissions, help prepare and deliver audit documents, and draft new materials as needed. You’ll help manage our annual compliance risk assessment and work plan, coordinate internal audit activities, and conduct mock audits to help team members prepare for their compliance responsibilities. Maintaining accurate documentation to the oversight of ‘First Tier and Down Stream’ entities and delegated entities. You’ll also assist with investigations, FWA, reports, and additional duties as needed to maintain a consistently compliant environment!

SENIOR COMPLIANCE ANALYST QUALIFICATIONS

• Bachelor's degree from a four-year college/university OR 1-2 years of related training or work experience OR an equivalent combination of education and experience
• Proven ability to read, analyze, and interpret legal and/or regulatory materials
• Working knowledge of federal sentencing guidelines, HIPAA, and privacy laws
• Knowledge of CMS, Medicare, and healthcare operations
• Proficiency in internet programs, word processing applications, publishing/database tracking systems, and Microsoft applications (particularly Word and Excel)
• PREFERRED - 4+ years of related experience in a Medicare Advantage and/or commercial-managed care environment

Required Skills & Competencies

• Strong literacy skills for reading, interpreting, and analyzing scientific/technical journals, financial reports, and legal documents
• Professional communication, customer service, and conflict resolution skills
• Solid math skills (i.e., exponentials, logarithms, permutations, quadratic equations, variance analysis, factor analysis, sampling theory)
• Analytical mindset with excellent research and problem-solving skills
• Ability to write speeches and articles for publication while complying with an outlined style and format
• Ability to clearly present information to management, boards of directors, and public groups
• Ability to define problems, collect data, establish facts, and draw reasonable conclusions
• Ability to accurately interpret technical instructions in mathematical or diagram form
• Ability to execute effective auditing, monitoring, and analytical compliance processes

ARE YOU READY?

The Senior Compliance Analyst ensures we continue to show up for our members and patients and serve the community the best we can. If you feel like the right fit, reach out today by completing our initial application!

CHP is proud to be an Equal Opportunity Employer and is committed to maintaining a workplace that values professionalism, integrity, and respect. We provide equal employment opportunities to all employees and applicants and do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other legally protected status.

Must have the ability to pass a background check and drug screening test.