Regulatory Compliance Project Specialist

HealthOne Alliance•Dalton, GA

18d

About The Position

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.

Requirements

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
Competency with Microsoft Word and Excel as well as Adobe Pro programs

Nice To Haves

Preferred experience in health insurance or related field

Responsibilities

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