VP of Operations, Independent Dispute Resolution
Dane Street
Salary
💰 $70,800 - $113,200 per year
Job Level
Mid-LevelSenior
About the role
- The Compliance Analyst II position is a professional compliance role responsible for supporting the Compliance Program by collaborating and overseeing high risk areas to ensure that the compliance program is effective and efficient in identifying, preventing, detecting, and correcting noncompliance.
- Provide analysis, interpretation, training, and education related to requirements as needed to ensure understanding and effective implementation of compliance requirements.
- Support departments with requirement implementation, reporting development, policy and procedure development/review, and readiness testing.
- Collaborate with internal business owners to ensure implementation of the health plan’s business and contractual requirements.
- Work with Compliance leadership to interpret regulations and provide related guidance.
- Investigate risks and issues with effective research, root cause analysis, and gap analysis for effective remediation and corrective action management.
Requirements
- Bachelor’s degree in business or related field, or equivalent years of relevant work experience is required.
- Minimum of three (3) years of compliance and/or regulatory experience including one (1) year in Government Program products is required.
- Strong familiarity with government-funded healthcare programs, including Medicaid, Marketplace, and Medicare, and the compliance standards imposed upon First Tier, Downstream and Related (FDR) entities.
- Familiarity with Healthcare operations and/or clinical concepts, practices and procedures is preferred.
- Data analysis ability to produce meaningful insight and drive appropriate action.
- Demonstrated understanding of Compliance and Regulatory fundamentals specifically related to managed care and government programs (CMS/HHS/DOI/Medicaid).
- Proven knowledge of internal and external audit functions and procedures.
- Ability to conduct research and analysis of Federal, State, and relevant industry regulatory and enforcement.
