GeBBS Consulting, a leader in Healthcare Technology solutions, has an immediate opening for a Regulatory Compliance Analyst to support a major healthcare partner in a remote capacity.

Position Description:

This position has responsibility for the preparation and communication of the monthly status report for the Business Units State of Compliance. They will integrate processes designed to support the implementation of all state and federal mandates to include work necessitated by future changes in the dynamic ACA environment. The Regulatory Compliance Analyst will incorporate complete transparency and accountability through the creation and maintenance of auditable supporting documentation such as Policies and Procedures, SOPs, workflows, and training materials.

What You’ll Get to Do:

· Assist the Manager in the development and implementation of the SBUs compliance program to ensure compliance and alignment with federal and state statutes and regulations.

· In consultation with Legal and Compliance & Ethics, ensure correct interpretation of the Federal and State regulatory operational requirements in the changing ACA environment, mitigating risk of exposure in the event of a conflict between the two.

· Assist the assigned Compliance Manager and Director in developing and implementing a comprehensive risk-based audit program to effectively test controls, continuously review, and improve departmental policies and procedures to achieve greater efficiencies and effectiveness.

· Provide support to the assigned Compliance Manager and Director in the interpretation of regulations and regulatory rules/guidelines to demonstrate the Business Unit and its delegated operations and entities comply state and federal standards.

· Maintain a central content repository by gathering and organizing compliance-related policies, applicable insurance laws and regulations and ensure a department policy and procedure exists for each law/regulation.

· Coordinate and schedule risk assessments assigned by the Compliance Manager and the Director of Communications, Compliance, Finance, and Sales Support.

· Analyze Business Unit operational area Policies and Procedures, SOPs, workflows, and systems and ensure they comply and align with regulations and remain updated and current.

· Review complex business processes, systems, workflows, SOPs, Policies and Procedures and policies to identify, document, and elevate the presence of risks and trends within, that may be non-compliant with contracts and/or statutory or regulatory requirements. Reviews will focus especially on the claims processing, enrollment, billing, reconciliation, and service arenas. Reviews will cover all applicable jurisdictions, all products, all processing platforms and will include our subsidiaries and vendors.

· Review internal controls, both manual and automated, and/or management controls in each functional area to remove any risk or exposure.

· Analyze controls for strengths and weaknesses ensuring special focus allocation to the specific risk areas creating the highest exposure to the Business Unit.

· Prepare reports that summarize risk assessment activities and communicate findings, conclusions, and planned remediation of findings.

· Implement process and forum to review risk assessment findings with stakeholders. Review risk assessment findings with appropriate management staff to ensure accuracy. Perform follow-up activities related to risk assessments to ensure corrective action and remediation occurs.

· Perform internal follow-up risk assessments on each functional group to ensure that the department has implemented corrective actions.

· Prepare reports on follow-up risk assessment activities.

· Work with Business Unit management to establish and implement corrective action plan as an outcome of any risk assessment findings.

· Monitor, assess, and report significant matters to the Compliance Manager and the Director of Communications, Compliance, Finance, and Sales Support.

· Compliance Incident Analysis and Response - In matters assigned by the Compliance Manager, apply regulatory mandates, process knowledge, and quality improvement principles to operational compliance issues affecting systems, manual processes, departmental data and other relevant operations that affect compliance, audit, or reporting requirements using analytical and problem resolution skills.

· Determine solution and provide recommendations for solutions or corrective action.

· Be responsible for mitigating risks, safeguarding assets, identifying fraudulent activities, complying with laws and regulations directly tied to operational efficiency.

· Remain abreast of emerging issues and developments that have direct impact on Business Unit.

· External Audit Management and Governance - In matters assigned by a Compliance Manager, assist the Business Unit in the management and response to external audits of operations.

· Implement process and forum to review audit findings with stakeholders. Review audit findings with appropriate management staff to ensure accuracy. Perform follow-up activities related to audits/reviews and special projects and ensure corrective action and remediation occurs. Perform internal follow-up audits on each functional group to ensure that the department has implemented corrective actions. Prepare reports on follow-up audit activities.

· Establish and implement corrective action plan as an outcome of any audit findings.

· Assist management by mitigating risks, safeguarding assets, identifying fraudulent activities, complying with laws and regulations directly tied to operational efficiency.

· Monitor, assess, and report significant matters to the Compliance Manager and the Director of Communications, Compliance, Finance, and Sales Support.

· Compliance 360 Governance, Risk, Compliance Policy Manual Maintenance - For documentation or functions assigned by the Compliance Manager, load Business Unit SOPs and job aids onto the CareFirst Compliance 360.

· Assist in the circulation and tracking of Business Unit SOPs loaded onto the Compliance 360 platform for annual review by each operational area.

· Prepare and circulate reports related to Compliance 360 SOP loading and review activities.

· Compliance Reporting - Update and maintain several departmental reports for internal use and for distribution to senior management.

You’ll Bring these Qualifications:

· Minimum of 3 years working experience in health insurance industry, managed care, government health programs, health insurance compliance programs, or related required.

· Bachelor’s degree is required.

· Minimum of 3 years working experience in at least one of the following areas is required: regulatory compliance analysis or evaluation, internal audit, risk assessment, project management, business process analysis, or work flow and task analysis. The ability to read and interpret insurance laws, regulations and policies is a must. Experience in state, federal regulatory oversight is required.

About GeBBS:

GeBBS Consulting has established itself as a leading technology and consulting partner for leading Health Plans, Hospitals, and many of the largest healthcare software firms. We are experts at mobilizing highly skilled teams and individual subject matter experts to assist deliver your projects on time and within budget.

Today’s healthcare industry is wildly complex and undergoing constant change. Our team of industry and technology experts will bring order to your mission critical projects and engage the necessary expertise to achieve successful delivery and completion.

Our core expertise includes Project / Program Management, Managed Care / Health Plan Systems, ACA / Mandates, EMR / Clinical / Meaningful Use, HIM / Certified Professional Coders.

GeBBS Consulting is an Equal Opportunity Employer.

Job Types: Full-time, Contract

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

COVID-19 considerations:
All candidates must be fully vaccinated against COVID-19 prior to start.

Experience:

• Compliance management: 2 years (Required)
• Medicare Advantage: 2 years (Required)
• Business analysis: 2 years (Required)

Work Location: Remote

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