Senior Compliance Analyst

Capital Health Plan•Tallahassee, FL

1d•Onsite

About The Position

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. 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!

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
Must have the 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

Making sure our work activities and documentation meet all federal, state, and regulatory laws/guidelines.
Researching, analyzing, auditing, and monitoring operational compliance functions for compliance with internal and external stakeholders, clearly communicating improvement suggestions when appropriate.
Working with internal/external partners to ensure compliance with all CMS, HPMS, and State regulations.
Performing in-depth reviews to verify accuracy, and meet all deadlines.
Reviewing and helping manage data validation audit activities/submissions.
Helping prepare and deliver audit documents, and drafting new materials as needed.
Helping manage our annual compliance risk assessment and work plan.
Coordinating internal audit activities, and conducting 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.
Assisting with investigations, FWA, reports, and additional duties as needed to maintain a consistently compliant environment.