Compliance Specialist
6 days ago
Focusing on compliance-driven healthcare access, Focus People seeks a detail-oriented professional to support Quality Health Plans and Stand-Alone Dental Plans in Georgia. This role involves policy implementation, monitoring, and effective communication with health insurance carriers.
Responsibilities- Policymaking: Develop policies for QHP/SADP applications, timelines, and data corrections to ensure adherence to state and federal standards.
- Regulatory Updates: Review annual regulatory updates (CCIIO guidelines, Payment Parameters) and revise processes as needed to maintain compliance.
- Compliance Reviews: Conduct thorough reviews of QHP applications to guarantee adherence to state and federal requirements.
- Re-enrollment and Carrier Communications: Manage annual auto re-enrollment and health carrier communications to prevent non-compliance issues.
- Accuracy Monitoring: Continuously monitor health insurance carrier information for accuracy in the Eligibility and Enrollment System.
- Corrective Action Planning: Develop corrective action plans for non-compliance incidents and support carrier relations through issue tracking and engagement.
- User Representation: Represent issuer interests during system requirement sessions and User Acceptance Testing (UAT).
- Employer Application Processing: Process employer applications for SHOP eligibility and maintain detailed records per federal and state guidelines.
- A minimum of four years of job-related experience or two years in a related compliance role.
- Familiarity with ACA, federal/state health insurance policies, and HIPAA regulations.
- Experience with ACA insurance plan credentialing and certification.
- Strong program management, data analytics, and reporting skills.
- Knowledge of health technology systems.
The estimated annual salary for this position is approximately $60,000-$80,000 depending on experience and qualifications.About Us
Focus People strives to provide meaningful opportunities for professionals to make an impact in the healthcare industry.
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Regulatory Compliance Specialist
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Product Compliance Specialist
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