Healthesystems

  • Advocacy & Compliance Analyst

    Job Locations US-FL
    Posted Date 2 weeks ago(8/5/2019 1:36 PM)
    ID
    2019-3128
    Type
    Regular Full Time 40
    Category
    Compliance/Legal
  • Summary

    ***Can consider 100% remote worker status for candidates outside the Tampa Bay area**

    Acts as the point person for emerging, new and existing regulatory changes for assigned region. Responsible for communication and consultation with impacted functional business areas during implementation of regulatory requirements. Researches, analyzes, interprets and summarizes emerging issues and new legislation/regulations to assist business in understanding operational impact. Documents business decisions related to implementation of regulatory changes.

    Key Responsibilities - To simplify complexities for each customer

    1. Works closely with manager and designated business units to develop a robust understanding of the company position on regulations which directly impact the company
    2. Monitors policy, legislative and regulatory developments to proactively evaluate impact of upcoming regulations
    3. Reviews and interprets external advisory committee agendas and committee meeting minutes, stakeholder workshops, informal and formal regulation proposals, fee schedule updates
    4. Accurately interprets proposed and adopted legislation and regulations as they relate to company business functions
    5. Produces documentation about regulatory requirements in easy to read language for internal and external customers.
    6. Provide consultative support to business units as they develop business requirements.
    7. Researches financial penalties to assist with risk assessment and prioritization of compliance initiatives
    8. Researches regulatory requirements in support of new products or services as assigned by manager
    9. Acts as liaison between Advocacy & Compliance Team and assigned functional business areas
    10. Assists management with the development of policies and procedures upon request
    11. Attends stakeholder or legislative hearings via teleconference or video streaming when available
    12. Responsible for escalation of issues with greatest financial or business impact to Manager for external regulatory engagement if needed

    Position Qualifications

     

    Qualifications/Education/Certifications:

    Bachelor's degree from four-year college or university; and a minimum of 5 years related experience and/or training; or equivalent combination of education and experience. Experience in workers’ compensation, managed care or medical bill review industry strongly preferred

    Knowledge, Skills and Abilities:

    Strong understanding of managed care and/or workers’ compensation concepts. Prefer experience in PBM or medical bill review environment. Basic understanding of EDI Medical State Reporting is a plus. Less than 10% travel required.

    Physical Demands/Working Conditions:

    Duties are performed primarily in an office setting. Travel to attend meetings and visit locations throughout the country may be required. Operate computer and standard office equipment such as telephone, copier, and printer. While performing the duties of this job, the employee is regularly required to sit and talk or hear. The employee is frequently required to use hands. The employee is occasionally required to stand and walk.

    *** Job descriptions will be reviewed and are subject to changes of business necessity. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

     

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