Senior Member Relations Compliance Specialist

jeffersonhealth; Philadelphia (Philadelphia County); Sur place; USD 70 000 - 90 000; Plein temps

Résumé du poste

Health Partners Plans, Inc. in Philadelphia, PA seeks a Compliance Analyst to monitor operational compliance across Medicaid, Medicare, CHIP PPO, and ACA programs. The role covers CMS, DHS, and NCQA guidance, audit support, and coordination with internal teams and vendors.

The candidate will develop processes, oversee data collection for audits, and educate staff on updates. Strong communication and ability to work independently are essential.

Qualifications

• Bachelor's Degree or equivalent work experience.
• 2 years of Medicare and Medicaid operational experience.
• Excellent written and verbal communication skills.
• Ability to work independently and meet deadlines.
• Proficiency with CMS, DHS, OOC guidance and NCQA standards.

Responsabilités

• Serve as a point of contact for CMS, DHS, and OOC communications.
• Review CMS, DHS, OOC and NCQA guidance and apply to Member Relations.
• Develop related processes and policies.
• Monitor and document operational compliance components.
• Communicate with internal management to ensure regulatory compliance.
• Assist with data collection for audits and maintain records.

Connaissances

Regulatory compliance

CMS/DHS guidance

Auditing experience

Communication skills

Independent worker

Formation

Bachelor's Degree or equivalent

Outils

DPW

Member Health Information System

Pharmacy Systems

Description du poste

Health Partners Plans, Inc. in Philadelphia, PA seeks a Compliance Analyst to monitor operational compliance across Medicaid, Medicare, CHIP PPO, and ACA programs. The role covers CMS, DHS, and NCQA guidance, audit support, and coordination with internal teams and vendors.

The candidate will develop processes, oversee data collection for audits, and educate staff on updates. Strong communication and ability to work independently are essential.