Compliance Analyst, Healthcare

Will coordinate the compliance oversight activities for Imperial and with first-tier, downstream, and related entities (FDRs), as necessary, to meet the contractual oversight regulatory requirements for the prevention, detection, and correction of Fraud, Waste and Abuse (FWA) and Medicare program non-compliance as established by the Centers for Medicare and Medicaid Services (CMS).

JOB TITLE:

Compliance Analyst

FLSA STATUS:
Exempt

DEPARTMENT:
Compliance

REPORTS TO:

Compliance Officer

Will coordinate the compliance oversight activities for Imperial and with first-tier, downstream, and related entities (FDRs), as necessary, to meet the contractual oversight regulatory requirements for the prevention, detection, and correction of Fraud, Waste and Abuse (FWA) and Medicare program non-compliance as established by the Centers for Medicare and Medicaid Services (CMS).

• Support the accurate and complete reporting of compliance activities to the compliance committees and external oversight entities.
• Review and interpret all regulatory communications applicable to the organization and FDRs and ensure that appropriate action is taken, including dissemination to applicable areas and implementation of changes as needed.
• Perform and assess the effectiveness of regulatory compliance training and education activities applicable to the Exchange line of business and other regulatory requirements.
• Coordinate and perform ongoing internal monitoring of activities, including tracking compliance and implementing appropriate action as required.
• Perform audits of operational areas and FDRs, whether desk or off-site, in accordance with the annual workplan or through ad hoc audits to determine compliance with CMS operational and Compliance Program requirements, including validation of data and internal controls.
• Review and submit comments, when necessary, for all assigned internal marketing reviews prior to their submission to CMS for approval.
• Participate in CMS webinars, seminars, and conference calls applicable to assigned responsibilities.
• Be responsible for the issuance and management of compliance actions due to non-compliance resulting from reported issues, monitoring, and auditing activities.
• Coordinate the timely and accurate completion of CMS and state reporting requirements and other required submissions.
• Perform appropriate CMS data submission quality checks and update developed tools as necessary.
• Monitor, analyze, and communicate CMS analyses and other reports related to compliance.
• Investigate and respond to reported issues and incidents of potential non-compliant or FWA activities.
• Coordinate with internal departments and FDRs on issues related to compliance and FWA.
• Coordinate and assist the Compliance Department in preparation activities for regulatory site visits and reviews.
• Coordinate with other members of the Compliance Department or throughout the organization when assigned activities overlap or as directed by Management.
• For FDRs, perform pre-contract reviews, designation of prospective FDR contracts, and pre-assessments to ensure prospective entities have policies, operations, and staff to fulfill the proposed contracted activities of the plan.
• For FDRs, communicate information regarding Imperial Health Plan's Compliance Program and monitor their adherence to requirements.
• Be responsible for supporting the implementation of the seven elements of a compliance program and FDR oversight.
• Maintain regular and consistent attendance.
• Adhere to the Compliance Plan and HIPAA regulations.

• Take on special projects as needed.
• Perform other duties as assigned.

• Attend staff meetings as required.
• Attend…