Healthcare Regulatory Compliance Analyst
Company: ALTA IT Services, LLC
Location: Baltimore
Posted on: February 25, 2021
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Job Description:
ALTA IT Services is seeking several Regulatory Analysts to join
our client in the Baltimore, MD area. Candidates must have proven
experience working in the health insurance industry. Please contact
ebrient@altaits.comRegulatory Compliance AnalystBaltimore, MD
(currently remote due to COVID)12+ month contractThis position will
work in collaboration with the Manager of Regulatory
Compliance.Duties and Responsibilities:--- Conduct regular review
and audit of internal controls within each functional area for
strengths and weaknesses ensuring special focus allocation to the
specific risk areas creating the highest exposure.--- Coordinate
the follow-up process for audit findings; develop and implement a
corrective action plan for any areas identified as risk
exposure.--- Provide regular monitoring and control of the
corrective action plan implementation.--- Communicate the risks
associated with the control deficiencies identified along with
regular investigative, analytic and audit reporting data to all
stakeholders.--- This position has responsibility for the
preparation and communication of the monthly status report for
State of Compliance.--- Integrate processes designed to support the
implementation of all state and federal mandates to include work
necessitated by future changes in the dynamic ACA environment.---
Incorporate complete transparency and accountability through the
creation and maintenance of auditable supporting documentation such
as Policies and Procedures, SOPs, workflows, and training
materials.--- Ensure correct interpretation of the Federal and
State regulatory operational requirements in the changing ACA
environment, mitigating risk of exposure in the event of a conflict
between the two.--- Assists the Manager and Director in developing
and implementing a comprehensive risk based audit program to
effectively test controls, continuously review, and improve
departmental policies and procedures to achieve greater
efficiencies and effectiveness.--- Provide support to the Manager
and Director in the interpretation of regulations and regulatory
rules/guidelines to demonstrate the organization and its delegated
entities are in compliance with state and federal standards.---
Maintain a central content repository by gathering and organizing
compliance-related policies, applicable insurance laws and
regulations and ensure a department policy and procedure exists for
each law/regulation.--- Review complex business processes, systems,
workflows, SOPs, Policies and Procedures and policies to identify,
document, and elevate the presence of risks and trends within, that
may be non-compliant with contracts and or statutory requirements
especially in the claims processing, enrollment and service arenas
- all jurisdictions, all products, all processing platforms to
include our subsidiaries and vendors.--- Review internal controls,
both manual and automated, and/or management controls in each
functional area to remove any risk or exposure.--- Analyze controls
for strengths and weaknesses ensuring special focus allocation to
the specific risk areas creating the highest exposure to the
Business Unit.--- Monitor, assess, and report significant matters
to the Compliance Manager and the Director of Performance,
Development, Compliance and Analysis.--- Apply continuous Quality
Improvement principles to system, processes, departmental data and
other relevant problems affecting audit and reporting requirements
using analytical and problem resolution skills.Requirements:---
Minimum of 3+ years working experience in health insurance
industry, managed care and government programs, health insurance
compliance programs, or related fields.--- A Bachelor's degree in
Business Administration or Healthcare Compliance is required.
Experience in project management, business process analysis, work
flow, and task analysis; The ability to read and interpret
insurance laws, regulations and policies is a must.--- Experience
in state, federal regulatory oversight is required..--- Excellent
oral and written communications; able to communicate and make
presentation to all levels of management and associates at all
levels throughout the CompanyThe top 3 skills that are required for
your rolea) Exceptional regulatory and compliance comprehensionb)
Advanced Excel and PC literate skillsc) Advanced analytical and
problem solving abilitiesd) Advanced communication, organization
and attention to detail abilityALTA IT Services, is an established
leader in IT Staffing and Services, specializing in Agile
Transformation Services, Program & Project Management, Application
Development, Cybersecurity, and Data & Advanced Analytics. We are
an equal opportunity/affirmative action employer and considers
qualified applicants for employment without regard to race, gender,
age, color, religion, disability, veteran status, sexual
orientation, or any other factor.
Keywords: ALTA IT Services, LLC, Baltimore , Healthcare Regulatory Compliance Analyst, Professions , Baltimore, Maryland
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