Overview:
As a Sr. Regulatory Compliance Analyst, you will monitor regulatory requirements impacting CareCentrix operations. You will be responsible for analyzing and documenting requirements, communicating and educating business areas, developing training programs to ensure an understanding of requirements, and working with business areas to modify operations, policies, and procedures to ensure compliance and securing and maintaining CareCentrix’s operational licenses (PPO, UM, TPA).
Responsibilities:
In this job you will:
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Secure and maintain required operational licenses including PPO, TPA, and UM licensures.
Monitor federal and state laws in 50 states, identify, and gather information on laws impacting CareCentrix’s operations, analyze the information, and prepare and circulate written communications to affected business areas regarding such laws.
Provide support, guidance and direction in the development of policies, procedures, and other operational changes necessary to comply with legal requirements and support the operational areas in the implementation of such policies, procedures, and other changes as required.
Create and implement compliance tracking, trending, and reporting tools.
Perform internal audits as needed and identify opportunities for improvement.
Develop and deliver training programs to ensure a clear understanding of compliance requirements.
Assist Senior Director of Regulatory Compliance in other matters as needed.
Adhere to and participate in the Company’s mandatory HIPAA privacy program / practices and Business Ethics and Compliance programs / practices.
Why you are going to love this role:
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You enjoy working with teams by building trust, fostering positive relationships and partnering with a diverse group of people.
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You like to move fast. You enjoy working through ambiguity and a changing market environment.
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You have the ability to function in a fast paced environment with high volume work output.
Qualifications:
You should apply to this role if:
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You have a Bachelor’s Degree preferred or a minimum of 5 years’ experience in a managed care / health plan setting.
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You have 5+ years experience working within Managed Care laws impacting health insurers and their delegated entities, including but not limited to, laws impacting utilization management, claims, and credentialing for commercial health plans.
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You have demonstrated experience in regulatory affairs and/or operations of commercial health insurers, HMOs, Exchanges, and/or government health plans.
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You have proficient in Microsoft Office: PowerPoint, SharePoint, and Excel.
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You have excellent legal research skills and attention to detail.
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JD Preferred or Paralegal experience preferred.
What we offer:
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Salary Range: $85000 - $107000 / year plus corporate bonus incentives.
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Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match
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Generous PTO, 401K Savings Plan, Paid Parental Leave, free on-demand Virtual Fitness Training and more
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Advancement Opportunities, professional skills training, and tuition /exam reimbursement
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PayActiv - access earned income in between pay checks
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Walgreens Discount - receive up to 25% off eligible items
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Great culture with a sense of community
CareCentrix maintains a drug-free workplace.
#IDCC
We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.
