Sr. Regulatory Compliance Analyst

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Senior Regulatory Compliance Analyst

The candidate will analyze and document 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 the firm’s operational licenses (PPO, UM, TPA). 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 the firm’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. Should have Bachelor’s Degree preferred or 5+ years’ experience in a managed care / health plan setting. JD is Preferred. Should 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. Demonstrated experience in regulatory affairs and/or operations of commercial health insurers, HMOs, Exchanges, and/or government health plans is required. Paralegal experience is preferred.

Additional Information

Job ID: 2022-14135

Company info

CareCentrix
20 Church Street 12th Floor
Hartford
Connecticut
United States 06103
Website : http://www.carecentrix.com/