Senior Compliance & Ethics Analyst; Remote

The Senior Ethics & Compliance Analyst will support the organizations ethics and compliance and its defined Ethics & Compliance Program. This position will ensure the implementation and maintenance of the annual Compliance Workplan for the organization while providing review and analysis of regulatory rules/guidelines, monitoring the organization's compliance performance, tracking Key Performance Indicators (KPIs)/Key Risk Indicators (KRIs), and supporting Program Integrity and Fraud, Waste, and Abuse (FWA) efforts.

The position will also monitor Corrective Action Plans (CAPs) established to address identified compliance issues and perform post-evaluation procedures for compliance implementation and remediation activities.

• Collaborates with business owners to establish and monitor action plans to address remediation of compliance risks. Works to ensure that root cause analyses are performed to address underlying issues when action plans are needed. Follows up with stakeholders to ensure remediation efforts are on track, successful, and validate that action plans have been implemented correctly. Regularly monitors CAPs implementation, communicate and report risks associated with identified control deficiencies to stakeholders.
  
  Provides reporting to the Ethics & Compliance leadership, documenting CAPs results, escalating risks and issues related to identification, implementation and remediation.
• Monitors compliance performance based on Compliance Risk Assessments to provide oversight. Reviews, analyzes, and distributes regulatory rules, guidelines and contractual requirements to educate impacted Care First business areas and delegated entities. Identifies and tracks required actions as the result of regulatory rules, guidelines and contractual requirements. Tracks and assesses KPIs and KRIs. Identifies compliance risks by gathering, reviewing and analyzing organizational data for downward trends or instances of non-compliance or potential non-compliance.
  
  Establishes, validates and implements FWA safeguards for the following: enrollee communications, excluded, sanctioned, or precluded providers, employees, enrollees and entities. Ensures consistent review of required government exclusion lists.
• Conducts investigations, research and due diligence to address compliance incidents, events, inquiries, and leadership concerns. Performs proactive and concurrent risk assessments to identify compliance risks associated with incidents, events, or company initiatives. Prepares clear, professional, and auditready responses to originating parties, ensuring timely resolution, complete and accurate answers, and adherence to member privacy requirements.
• Supports and drives the continued maturity of Care First compliance through on-going education, development of compliance tools, initiatives and collaboration with other related risk functions (e.g., Internal Audit, Executive Inquiry, Privacy) to respond to compliance incidents, gaps, and identified risks. Support the development, implementation, and maintenance of written policies and procedures. Collaborates and contributes to Companys standards of conduct. Supports the maintenance of required Compliance committees.
  
  Monitors that all necessary parties, as per policy, receive effective training and education as well as supporting third-party onboarding and annual attestation processes.
• Assists with the performance of post-implementation procedures to validate performance of compliance requirements resulting from mandates, regulatory and contractual changes, systems, or partner implementations. Conducts compliance review of prospective and current member materials (and other materials as required) against regulatory, contractual, Company, and Blue Cross Blue Shield Association (BCBSA) requirements. Prepares and submits to regulators as applicable.

Education Level: Bachelor's Degree.

• CHC - Certified Healthcare Compliance or
• Certified Compliance & Ethics Professional (CCEP)

5 years knowledge of ethical, corporate compliance with demonstrated ability to apply elements of the Federal Sentencing Guidelines for organizations and experience with compliance and/or regulatory or legal programs.

• Experience in an operational capacity in the health care or health care insurance industry which can be in a state Medicaid program or a CMS Medicare Advantage…