Compliance Analyst I

Job Summary:

The Compliance Analyst I is responsible for management of activities to support the compliance organization.

Essential Functions:

Support the Compliance Program with internal or external audit and monitoring, departmental projects, and data analytics to ensure proper execution of the Compliance work plan and priorities

Perform data entry and management of compliance requests in the designated compliance tools

Support and/or coordinate audit activities with impacted business owners to ensure adequate representation from subject matter experts (SME) for external reviews and audits

Collaborate with internal business owners to determine appropriate action and ensure timely delivery of accurate documents, reports, and data universes prior to submission to regulatory agencies

• Identify and communicate irregular trends, recommend  possible improvement opportunities, and relay information to management to be researched when necessary
• Track and report key statistics for adherence to internal and external requirements
• Collaborate with Internal Business Partners to identify efficiencies in workflows to maximize productivity
• Perform recurring business continuity/audit processes related to physical content, as needed
• Support internal projects and interact with cross-functional teams to complete project deliverables
• Assist in the development, review and delivery of compliance support training within Compliance and other business areas
• Assist in development and maintenance of corrective action plan information through resolution of issues
• Conduct research, root cause and gap analysis
• Work with Compliance leadership to interpret regulations and provide related guidance
• Coordinate internal quality review process to ensure consistency in submissions and communication to regulatory agencies
• Identify potential areas of compliance vulnerability and risks and report potential risks, non-compliance or alleged violations to appropriate Compliance Leadership
• Establishes working relationships and builds credibility with the Business Departments to support a culture of compliance

Collaborate cross functionally between the Compliance functions throughout corporate, markets and plans, other assurance functions, and business partner areas to foster a culture of compliance

Analyze relevant business and/or delegate/FDR performance data and prepare reports for leadership and business owners

May include management of complaints received through regulators and/or other governing bodies, as well as the overall maintenance of the Records & Information Management Program and Corporate Policy & Procedure Governance

Perform any other job-related instructions as requested

Education and Experience:

Bachelor’s degree or equivalent years of relevant work experience is required

One (1) to two (2) years in a health care related field is required or an equivalent experience level in the following: experience in managed care, compliance, regulatory environment, or policy and procedure development and oversight and/or records and information management

Competencies, Knowledge and Skills:

Highly motivated individual with the ability to work independently in a fast-paced cross-functional environment with changing priorities

Strong interpersonal and verbal/written communication skills

Demonstrated professional communication skills, to include proper grammar usage, document structure, and business writing to audiences including, but not limited to, internal Leadership at all levels, internal Legal Counsel, Corporate Compliance, State and Federal Regulators

• Ability to work independently and within a team environment
• Demonstrated success in working in a matrixed environment
• Maintain positive and strategic relationships with internal stakeholders
• Strong analytical, problem solving, and critical thinking skills, with attention to detail
• Knowledge of regulatory environment and general understanding of audit protocols
• Ability to read, comprehend and adhere to process documents, contractual requirements, and technical specifications required by auditors and regulators
• Ability to evaluate internal business partners’ adherence to procedures, contractual requirements and technical specifications required by auditors and regulators
• Familiarity with Healthcare operations and/or clinical concepts, practices and procedures
• Must be able to manage multiple responsibilities and projects with competing priorities and deadlines to ensure effective project management
• Understanding of data analysis and trending techniques for reporting results in a meaningful manner
• Display a customer service, member-focused orientation
• Ability to develop, prioritize, leverage resources, and accomplish goals
• Ability to schedule projects with strong time management skills including creation and maintenance of project timelines
• Follows procedures, ensures high-quality output, takes action to correct problems

Knowledge of various IT and enterprise software applications and platforms, such as SharePoint, OnBase, Adobe, etc.

Proficient in Microsoft Word, Excel and PowerPoint

Licensure and Certification:

Certified Records Analyst (CRA); Certified Healthcare Compliance (CHC) or Certified Compliance Ethics Professional (CCEP) certification preferred

Working Conditions:

General office environment; may be required to sit or stand for extended periods of time

May be required to lift or move objects such as boxes up to 50 pounds