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

Compensation Range:

$62,700.00 - $100,400.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

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About Us

The CareSource mission is known as our heartbeat. Just as we support our members to be the best version of themselves, our employees are driven by our mission to create a better world for members, stakeholders and providers.

We are difference-makers who combine compassionate hearts with our unique business expertise to make every opportunity count. Each claim, each phone call, each consumer-centric decision is a chance to change the world for one member, and our employees look for ways to do that every day.

The challenge is, there is no one right way to be the difference and we’re looking for people like you that will rewrite that definition every day. We do what it takes to form creative solutions that make our community and the world just a little better. Discover what it means to be #UniquelyCareSource.