Virginia Premier Health Plan, Inc.

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Compliance Analyst II

Compliance Analyst II

Job Locations 
US-VA-Glen Allen
Job ID 
2017-4102

Job Description

Overview

Assist in the implementation, ongoing development and maintenance of the Medicaid & Medicare Plan compliance program to support the operation of Medicare/Medicaid plans affiliated with Virginia Premier Health Plan.  Maintain knowledge of the business and regulatory environment relative to Medicare managed care, Medicare Advantage Part A&B and Medicare Part D.  Maintain general knowledge of other plan product lines, business activities, and initiatives.  Analyze regulatory requirements for organizational impact and implementation.  Advise and collaborate with management on policies and procedures as they relate to the regulatory expectations.

 

Responsibilities

  • Plan and manage large-scale initiatives to ensure timely and accurate completion of program objectives
  • Ensure business units understand and adhere to federal and state regulations.
  • Review all Part C and Part D documents and communications received from CMS or its designees and coordinate deliverables to ensure compliance
  • Process and coordinate all elements of the annual CMS Readiness Checklist
  • Participate in developing and enhancing FWA training and FDR vendor oversight.
  • Lead and participate in various regulatory audits
  • Document and process all CMS and DMAS inquiries accurately and in conformance with required timelines
  • Receive and coordinate distribution and follow-up of all HPMS Memos
  • Receive and coordinate timely and accurate entry of regulatory reporting requirements
  • Develop & implement system to track and monitor compliance of regulatory deliverables including reports, requests, requirements, etc.
  • Provide oversight to the Policy Committee and operation of the Policy Manager system.
  • Develop and maintain policies & procedures to foster a culture of compliance; continually monitor and evaluate the adequacy and efficacy of policies, procedures and company adherence.
  • Collaborate with business owners to determine root cause and remediation of compliance issues.

Qualifications

MINIMUM EDUCATION REQUIREMENTS

  • B.S. Degree in Health Care Administration, Business or related field
  • Relevant work experience can substitute for a Baccalaureate Degree.

SPECIAL KNOWLEDGE AND/OR SKILLS

 

  • General knowledge of regulatory and/or compliance processes impacting managed health care
  • Demonstrated organization, facilitation, and presentation skills
  • Ability to communicate effectively with health professionals and administrators
  • Ability to build strong relationships within and outside the health plan
  • Knowledge and experience of government programs, particularly Medicare, and knowledge of managed care
  • Exposure to HIPAA/HITECH regulations desirable
  • Demonstrated oral and written communication skills

           

WORK BACKGROUND/EXPERIENCE

 

  • Three plus years in a combination of insurance, contracting, and compliance responsibilities
  • Demonstrated experience with a Medicare managed care program
  • Experience in Medicaid managed care preferred
  • Previous experience in healthcare regulatory affairs preferred
  • Previous experience in conducting audits preferred
  • Intermediate MS Office proficiency with Word and Excel

 

PHYSICAL REQUIREMENTS

  • Physical health sufficient to meet the ergonomic standards and demands of the position.

About Us

Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 

 

We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  

 

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

 

Our mission is to inspire healthy living within the communities we serve!

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