Health Plan Compliance Analyst

Health Plan Compliance Analyst

We are seeking a Health Plan Compliance Analyst to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.

About the Role:

The Health Plan Compliance Analyst plays a critical role in ensuring that health plans operate within the regulatory frameworks established by federal and state laws. This position involves conducting thorough reviews and audits of health plan policies, procedures, and operations to identify compliance risks and recommend corrective actions. The analyst collaborates closely with cross-functional teams to implement compliance strategies that safeguard the organization from legal and financial penalties. Additionally, the role requires staying current with evolving healthcare regulations and industry best practices to proactively address compliance challenges. Ultimately, the Health Plan Compliance Analyst helps maintain the integrity and trustworthiness of the health plan by promoting adherence to all applicable standards and regulations.

Minimum Qualifications:

• Bachelor's degree in Health Administration, Public Health, Business, or a related field.
• Minimum of 3 years of experience in healthcare compliance, health plan operations, or a related area.
• Strong knowledge of federal and state healthcare regulations, including HIPAA, ACA, and CMS guidelines.
• Proficiency in conducting audits and risk assessments within healthcare settings.
• Excellent written and verbal communication skills.
• Relevant experience may substitute for the educational requirement on a year-for-year basis.

Preferred Qualifications:

• Master's degree in Health Administration, Public Health, Business, or a related field.
• Certification in healthcare compliance such as Certified in Healthcare Compliance (CHC) or equivalent.
• Experience working with managed care organizations or health insurance plans.
• Familiarity with healthcare data analytics and compliance software tools.
• Advanced degree in healthcare administration, law, or a related discipline.
• Demonstrated ability to lead compliance projects and cross-functional teams.

Responsibilities:

• Conduct detailed compliance audits and assessments of health plan operations to ensure adherence to regulatory requirements.
• Monitor changes in healthcare laws and regulations, interpreting their impact on organizational policies and procedures.
• Develop and maintain compliance documentation, including policies, procedures, and training materials.
• Collaborate with internal departments such as legal, operations, and quality assurance to address compliance issues and implement corrective actions.
• Prepare reports and present findings to senior management and regulatory bodies as required.
• Support the development and delivery of compliance training programs for staff across the organization.
• Investigate and respond to compliance inquiries and potential violations in a timely and effective manner.