Senior Embedded Compliance Analyst

Senior Embedded Compliance Analyst

Support the Health Services Division's Embedded Compliance in driving accountability for MHPAEA activities.

Execution of a MHPAEA program to implement, revise and test controls and reviews and improves MHPAEA policies and procedures to achieve greater efficiencies and effectiveness. Acts as a liaison across areas, including of Health Services, Corporate Audit, Corporate Compliance, Finance, and Legal.

Ensure MHPAEA documentation is developed and maintained for inquiries and submissions. Drives the development of workflow processes to help ensure preparedness for MHPAEA inquiries and audits to manage and minimize the impact on the multi-departmental workforce and teams. Analyzes and aligns Health Services MHPAEA policies, procedures, SOPs, workflows, and systems and helps ensure alignment with regulations and remain updated and current.

Provide regular investigative, analytic and audit reporting data to stakeholders. Monitors, assesses and reports significant matters. Support MHPAEA audits and manages the activities related to reviewing audit findings with stakeholders. Works with Divisions management to establish and implement corrective action plan as an outcome of audit findings. Regular monitoring of corrective action plan implementation and communication/reporting of risk associated with the control deficiencies identified. Actively participate in implementation/corrective workgroups to ensure compliance perspectives and concerns are addressed through the process.

Works directly with the Divisions Training teams to ensure MHPAEA training and documentation of policies, procedures, SOPs, workflows, etc., applicable to MHPAEA. Keeps abreast of MHPAEA and related regulations and uses the information to update the program and help maintain compliance

Education Level: Bachelor's Degree in Business Administration, Healthcare Compliance or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience: 5 years experience in health insurance industry, managed care and government programs, health insurance compliance programs, or related fields.

Knowledge, Skills and Abilities (KSAs):

• Excellent interpersonal skills with ability to build consensus and agreement and bring resolution to contentious issues and entrenched interests, Proficient
• Ability to present and discuss regulatory compliance goals in a way that establishes rapport, persuades others, and gains commitment, Proficient
• Ability to research complex issues, interpret regulations and regulatory rules/guidance, and exhibit sound judgment in determining a recommendation or solution to a problem, Advanced
• Word, Advanced Excel and database management and related software applications, Advanced
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
• Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
• Licenses/Certifications CHC - Certified Healthcare Compliance CRCMP - Certified Risk And Compliance Professional Lean Six Sigma Certification-IASSC Certified Regulation Analyst Certified Compliance & Ethics Professional (CCEP)

Additional Skills: Top 5 Required Skillsets

• managed healthcare/payer experience; preferably includes exposure to Behavioural Health
• large scale project management
• writing skill
• analysis and problem solving
• compliance - awareness and exposure to Mental Health Parity legislation/mandates is a plus.