Compliance Analyst - Health Insurance

Job Overview

Description

Are you someone with a 4-year/Bachelor’s degree who enjoys research, writing, digging into new and interesting topics, and being the resource and answer hub? If so, Medical Associates Health Plans is hiring a Compliance Analyst!

As a Compliance Analyst, you will be responsible for monitoring of and research  laws and regulations that impact MAHP products and services. You will also communicate and educate internally regarding these laws and regulations, and coordinates activities and procedures to maintain, assure and demonstrate compliance with these laws and regulations.

The Position:
Implement compliance activities, processes and procedures for Medical Associates Health Plans and Health Choices which maintain adherence with State, Federal, CMS and MAHP Guidelines. Perform necessary review and research on State, Federal, CMS, DOL and IRS regulations to assure compliance.

Schedule: Mon-Fri, 8:00-5:00

Benefits Package Includes:

• Single or Family Health Insurance with discounted premium rates for wellness program participation.
• 401k with immediate matching (50% on the dollar up to 7% of pay) + additional annual Profit Sharing
• Flexible Paid Time Off Program (24 days off/year)
• Medical and Dependent Care Flex Spending Accounts
• Life insurance, Long Term Disability Coverage, Short Term Disability Coverage, Dental Insurance, etc.

Skills Needed: 

• Effective writing and communication skills
• Ability to dive in and research topics
• Strong organization skills

Essential Functions & Responsibilities:

• Monitor, review and analyze State and Federal laws and regulations that impact Medical Associates Health Plan products and services; communicate with management and staff regarding laws and regulations; recommend and assist in implementation of processes and procedures to maintain and assure compliance.
• Independently prepare and amend Plan Documents/SPDs and Plan amendments for Medical, Dental, Health Reimbursement, Flexible Spending and Health Savings Accounts to maintain compliance with applicable laws and client needs and directions, including for self-funded plans. Work with internal staff as necessary regarding communication of benefits and interpretation of Plan Documents. Review requirements and make recommendations for discussion with self-funded clients.
• Implement compliance activities, processes and procedures in accordance with State, Federal, CMS, ERISA and MAHP Guidelines. Perform necessary compliance research and review.
• Coordinate activities, work plan, minutes, policies and procedures and research related to the MAHP Compliance Committee to assure compliance with regulatory requirements; develop and provide education on MAHP Compliance Program and Fraud, Waste and Abuse, as necessary; assist in development and implementation of audits, activities and reporting to document compliance throughout MAHP.
• Monitor, review and analyze CMS, HPMS, Med Learn and other CMS Communications for changes impacting MAHP. Review, analyze, recommend and implement necessary changes to assure compliance and communicate throughout MAHP on same.
• Coordinate and facilitate annual review and revision of Commercial Subscriber Agreements, Schedules of Benefits, and Summaries of Benefits and Changes.
• Assist with Medicare HPMS, and CMS filings as necessary.
• Complete all other assigned projects and duties. 

Knowledge, Skills & Abilities:

Experience: Five years to ten years of similar or related experience.

Education: Equivalent to a Bachelors/4 year degree.

Interpersonal Skills: A significant level of trust and diplomacy is required, in addition to normal courtesy and tact. Work involves extensive personal contact with others and/or is usually of a personal or sensitive nature. Work may involve motivating or influencing others. Outside contacts become important and fostering sound relationships with other entities (companies and/or individuals) becomes necessary.  

Other Skills: Background in research and writing preferred. Legal training, college research focus such as English or history preferred. Experience in managed care/employee benefits.

Physical Aspects:

Reaching - Extending hand(s) and arm(s) in any direction.

Lifting - Raising objects from a lower to a higher position or moving objects horizontally from position-to-position. This factor is important if it occurs to a considerable degree and requires the substantial use of the upper extremities and back muscles.

Fingering - Picking, pinching, typing or otherwise working, primarily with fingers rather than with the whole hand or arm as in handling.

Grasping - Applying pressure to an object with the fingers and palm.

Talking - Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly or quickly.

Hearing - Perceiving the nature of sound with or without correction. Ability to receive detailed information through oral communication and to make fine discriminations in sound, such as when making fine adjustments on machined parts.

Repetitive Motions - Substantial movements (motions) of the wrists, hands and/or fingers.

Sedentary Work - Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Environmental Conditions:
None - The worker is not substantially exposed to adverse environmental conditions (such as in typical office or administrative work).

Medical Associates Clinic & Health Plans is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, pregnancy, age, national origin, marital status, parental status, disability, veteran status, or other distinguishing characteristics of diversity and inclusion, or any other protected status.

Please view Equal Employment Opportunity Posters provided by OFCCP here.