The Senior Compliance Analyst is responsible for maintaining and fostering an environment that enhances and promotes compliance. This position works with the Sr. Mgr. Government Programs in the planning and execution of compliance reviews and activities for all product lines in the State.
Duties/Responsibilities:
- Supports the Healthfirst Compliance Program Develop and implement action plans to support continued compliance.
- Understands and utilizes operational data to help identify Compliance risk areas as well as improvement opportunities based on industry best practices.
- Supports the annual Compliance Risk Assessment process.
- Communicates compliance requirements to business teams in a clear and concise manner.
- Performs operational monitoring and corrective action plans testing to identify and help address areas of noncompliance with CMS and/or NYSDOH requirements.
- Requests Corrective Action Plans (CAPs) as appropriate to address Compliance deficiencies and ensure ongoing compliance with regulatory standards.
- Recommends improvements in operating policies and practices while ensuring required corrective actions plans are achieved.
- Creates detailed Compliance status reports that inform management of departmental monitoring and audit results.
- Proactively cultivates and maintains strong, positive working relationships with internal and external customers.
- Maintains confidentiality of all information related to members, medical staff, employees, integrity issues, audits and as appropriate, other information.
- Follows established and newly implemented changes in departmental policy as well as Federal and State government requirements.
Minimum Qualifications:
- Prior experience working in a compliance function.
- Prior experience in the healthcare industry working with regulatory monitoring activities.
- Knowledge of federal & state regulatory compliance programs.
- Proficient in identifying regulatory deficiencies and opportunities for process improvement.
- Intermediate experience in using Excel (v-lookups + complex formulas + pivot tables).
- Well versed in Microsoft Office Suite (Word, PowerPoint) + SharePoint.
- High school diploma/GED plus relevant compliance experience.
Preferred Qualifications:
- Working knowledge of platforms/tools: CareMark, TruCare, OnBase, MHS, Salesforce, MedHOK, MHK MarketProminence
- Bachelor's Degree from accredited institution.
- Excellent written and verbal communication skills.
- Must be detail oriented.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.
EEO Law Poster and Supplement
All hiring and recruitment at Healthfirst is transacted with a valid "@healthfirst.org" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.
Hiring Range:
- Greater New York City Area (NY, NJ, CT residents): $79,300 - $114,580
- All Other Locations (within approved locations): $69,800 - $103,870
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.