Compliance Analyst

2 weeks ago

Pasadena, United States Imperial Management Administrators Services Full time

People are the most important asset of Imperial, for this reason the difference and plurality of people, equality of opportunities, non-discrimination and inclusion in the workplace are priority and strategic factors in the Organization. Imperial maintains a strong will to promote Diversity, Equity, and Inclusion, through inclusive leadership as a lever change and business sustainability.

Imperial Health Plan of California, Inc. is approved by California Department of Managed Health Care to offer full-service Medicare Advantage coverage, including a Medicare Advantage Prescription Drug plan, and a Chronic Condition Special needs plan over numerous counties in California. Through its affiliate, Imperial Insurance Companies, Imperial also offers Medicare Advantage plans in Texas, New Mexico, Utah, and Arizona.

Our Mission: To deliver valuable care so that members are healthy in body, mind, and spirit to achieve their inherent potential.

Our Vision: To deliver value based care that is clinically effective, sustainable, and achieves exceptional outcome.


JOB SUMMARY: 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).


ESSENTIAL JOB FUNCTIONS:

1. Responsible for supporting the implementation of the seven elements of a compliance program and FDR oversight.

2. Perform audits of operational areas and FDRs (desk or off-site) in accordance with annual workplan or ad-hoc audits to determine compliance with CMS operational and Compliance Program requirements, including validation of data and internal controls.

3. Perform and assess the effectiveness of regulatory compliance training and education activities applicable to Medicare Advantage and other regulatory requirements.

4. Responsible for the issuance and management of compliance actions due to non-compliance resulting from reported issues, monitoring, and auditing activities.

5. 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.

6. Coordinate and perform ongoing internal monitoring of activities including tracking compliance and implementing appropriate action as required.


EDUCATION/EXPERIENCE:

· High school graduate or equivalent.

· Bachelor’s degree preferred and/or 3 to 5 years related work experience in a Medicare Advantage Plan

. Required 2 years exp of Medicare Regulatory Requirements (Medicare Managed Care Manuals)

· Required 2 years Medicare compliance experience or in lieu, two years working with CMS

government program, including working knowledge of Medicare Advantage Prescription Drug plan organization and structure

· Medicare Audit experience preferred


SKILLS/KNOWLEDGE/ABILITY:

· Strong computer skills including proficiency in word processing, spreadsheet, and database management skills required

· Knowledge of CMS and State regulatory guidelines related to job functionality

· Ability to work independently

· Strong communications and interpersonal skills

· Ability to meet deadlines

· Ability to maintain an appropriate level of confidentiality and privacy


LICENSURE/CERTIFICATE/TRAINING:

Certified in Healthcare Compliance (CHC) preferred

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