ALTA IT Services is seeking several Regulatory Analysts to join our client in the Baltimore, MD area. Candidates must have proven experience working in the health insurance industry. Please contact [ Link Removed ]
Regulatory Compliance Analyst
Baltimore, MD (currently remote due to COVID)
12+ month contract
This position will work in collaboration with the Manager of Regulatory Compliance.
• Minimum of 3+ years working experience in health insurance industry, managed care and government programs, health insurance compliance programs, or related fields.
• A Bachelor's degree in Business Administration or Healthcare Compliance is required. Experience in project management, business process analysis, work flow, and task analysis; The ability to read and interpret insurance laws, regulations and policies is a must.
• Experience in state, federal regulatory oversight is required..
• Excellent oral and written communications; able to communicate and make presentation to all levels of management and associates at all levels throughout the Company
The top 3 skills that are required for your role
a) Exceptional regulatory and compliance comprehension
b) Advanced Excel and PC literate skills
c) Advanced analytical and problem solving abilities
d) Advanced communication, organization and attention to detail ability
ALTA IT Services, is an established leader in IT Staffing and Services, specializing in Agile Transformation Services, Program & Project Management, Application Development, Cybersecurity, and Data & Advanced Analytics. We are an equal opportunity/affirmative action employer and considers qualified applicants for employment without regard to race, gender, age, color, religion, disability, veteran status, sexual orientation, or any other factor.
Duties and Responsibilities:
• Conduct regular review and audit of internal controls within each functional area for strengths and weaknesses ensuring special focus allocation to the specific risk areas creating the highest exposure.
• Coordinate the follow-up process for audit findings; develop and implement a corrective action plan for any areas identified as risk exposure.
• Provide regular monitoring and control of the corrective action plan implementation.
• Communicate the risks associated with the control deficiencies identified along with regular investigative, analytic and audit reporting data to all stakeholders.
• This position has responsibility for the preparation and communication of the monthly status report for State of Compliance.
• Integrate processes designed to support the implementation of all state and federal mandates to include work necessitated by future changes in the dynamic ACA environment.
• Incorporate complete transparency and accountability through the creation and maintenance of auditable supporting documentation such as Policies and Procedures, SOPs, workflows, and training materials.
• Ensure correct interpretation of the Federal and State regulatory operational requirements in the changing ACA environment, mitigating risk of exposure in the event of a conflict between the two.
• Assists the Manager and Director in developing and implementing a comprehensive risk based audit program to effectively test controls, continuously review, and improve departmental policies and procedures to achieve greater efficiencies and effectiveness.
• Provide support to the Manager and Director in the interpretation of regulations and regulatory rules/guidelines to demonstrate the organization and its delegated entities are in compliance with state and federal standards.
• Maintain a central content repository by gathering and organizing compliance-related policies, applicable insurance laws and regulations and ensure a department policy and procedure exists for each law/regulation.
• Review complex business processes, systems, workflows, SOPs, Policies and Procedures and policies to identify, document, and elevate the presence of risks and trends within, that may be non-compliant with contracts and or statutory requirements especially in the claims processing, enrollment and service arenas – all jurisdictions, all products, all processing platforms to include our subsidiaries and vendors.
• Review internal controls, both manual and automated, and/or management controls in each functional area to remove any risk or exposure.
• Analyze controls for strengths and weaknesses ensuring special focus allocation to the specific risk areas creating the highest exposure to the Business Unit.
• Monitor, assess, and report significant matters to the Compliance Manager and the Director of Performance, Development, Compliance and Analysis.
• Apply continuous Quality Improvement principles to system, processes, departmental data and other relevant problems affecting audit and reporting requirements using analytical and problem resolution skills.