Provide analysis, interpretation, training, and education related to requirements as needed to ensure understanding and effective implementation of compliance requirements
Support departments with requirement implementation, reporting development, policy and procedure development/review, and readiness testing
Collaborate with internal business owners to ensure implementation of the health plan’s business and contractual requirements
Work with Compliance leadership to interpret regulations and provide related guidance
Provide Compliance Program support with audit and monitoring, corrective action plan management, data analytics and other projects to ensure proper execution of the Compliance Program workplan and priorities
Analyze relevant business and/or delegate/FDR performance data to ensure compliance with requirements and prepare reports for leadership and business owners
Proactively use analytic and research skills to identify potential areas of risk to CareSource and make recommendations or escalate to Compliance Management for issue management, external audit enforcement trending, and related industry corrective actions
Investigate risks and issues with effective research, root cause analysis, and gap analysis for effective remediation and corrective action management

Bachelor’s degree in business or related field, or equivalent years of relevant work experience is required
Minimum of three (3) years of compliance and/or regulatory experience including one (1) year in Government Program products is required
Strong familiarity with government-funded healthcare programs, including Medicaid, Marketplace, and Medicare
Familiarity with Healthcare operations and/or clinical concepts, practices and procedures is preferred
Data analysis ability to produce meaningful insight and drive appropriate action
Proven knowledge of internal and external audit functions and procedures
Ability to conduct research and analysis of Federal, State, and relevant industry regulatory and enforcement

Compliance Analyst II

Key skills