Senior Compliance Analyst

Capital Health Plan•Tallahassee, FL

5d•Onsite

About The Position

Capital Health Plan invites you to join our Tallahassee, FL team as a full-time 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, and auditing compliance functions for 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 CHP regulations, perform in-depth reviews to verify accuracy, and meet all deadlines. Prioritizing accuracy and thoroughness, you'll validate data activities/submissions, help prepare and deliver audit documents, and draft new materials as needed. You'll 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 organization, you'll update documentation related to 'First Tier and Down Stream' entities and delegated entities. You'll also assist with investigations, reports, and additional duties as needed to maintain a consistently compliant environment!

Requirements

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)
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
Ability to pass a background check and drug screening test.

Nice To Haves

4+ years of related experience in a Medicare Advantage and/or commercial-managed care environment

Responsibilities

Make sure work activities and documentation meet all federal, state, and regulatory laws/guidelines.
Research, analyze, and audit compliance functions for internal and external stakeholders.
Communicate improvement suggestions when appropriate.
Ensure compliance with all CMS, HPMS, and CHP regulations.
Perform in-depth reviews to verify accuracy.
Meet all deadlines.
Validate data activities/submissions.
Help prepare and deliver audit documents.
Draft new materials as needed.
Manage the annual compliance risk assessment and work plan.
Coordinate internal audit activities.
Conduct mock audits to help team members prepare for their compliance responsibilities.
Update documentation related to 'First Tier and Down Stream' entities and delegated entities.
Assist with investigations, reports, and additional duties as needed to maintain a consistently compliant environment.