Regulatory Performance Analyst III - 240659DESCRIPTION/RESPONSIBILITIES:
The Regulatory Performance Analyst III serves as Subject Matter Expert (SME) and compliance consultant for assigned business areas. Responsible for maintaining productive relationships with leaders in business areas falling under their SME purview. Anticipating compliance needs, communicating regulatory requirements to operational areas and conducting follow up to assure implementation. Analyzes and clarifies regulatory, sub regulatory guidance as required, for business areas and obtains clarification of guidance as appropriate. Stays continuously up to date with best practices across the industry, especially other Blues, seeks opportunities to enhance compliance and keeps business areas up to date. Identifies possible compliance issues, assists with investigation and resolution, escalating issues when appropriate. Conducts monitoring to measure compliance with Federal and State regulations and guidance, communicates findings to impacted business areas and completes follow up to assure resolution of the identified issues.Responsibilities:
Provide regulatory interpretation, analysis and make recommendations to management.
Independently and proactively use compliance tools to identify trends within their area, forecast potential compliance issues and make recommendations to management for Corrective Action Plans.
Continuous environmental scanning to maintain a thorough awareness of compliance environment, Federal and state priorities, potential new guidance and best practices.
Demonstrate compliance expertise in multiple areas.
Coordinate with each business area to review rules and regulations against policies and procedures and document changes when necessary.
Independently manage corrective action plans per the updated P&P, effectively documenting the complete issue lifecycle from identification to remediation.
Proactively ensure reported issues are updated weekly on the CMS Disclosed Issues Grid
Organize and facilitate meetings in which the requirements are presented to the business.
Expert compliance knowledge of multiple SME areas
Work closely with business area partners within their SME purview ensuring they are engaged and prepared to report results at all compliance committees and workgroups.
Act as a liaison between CMS Regional Offices and Independence when needed
Assist in the development of processes to address non-compliance when identified through internal audit, self-assessments, or Federal and state audits.
Conduct monthly Call Center Monitoring reviewing customer service calls and providing feedback as appropriate
Provides oversight to Regulatory Compliance Analysts I and II's.
Other duties as assignedQualifications
Bachelor's degree in related field or equivalent work experience.
Minimum of 5 years related work experience in managed care or health care compliance.
Excellent critical thinking, organization, verbal and written communication skills required.
Working knowledge of Microsoft Office products required.
Knowledge of Federal and/or State regulations related to the health insurance industry is an asset.Independence has implemented a "Hybrid" model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the "Hybrid" model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey or Pennsylvania.Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.Equal Opportunity Employer-minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity
