Compliance Analyst

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Compliance Analyst
Duties: Create and maintain databases and spreadsheets related to regulatory submissions and reporting, licensing, contracts, policies, procedures, laws and regulations. Understand and prioritize timeframes associated with CMS Medicare Advantage (MA) Prescription Drug (PD), federal and state regulatory submissions/reporting calendar, AHP Compliance Toll-Free Hotline, CMS Complaint Tracking Module (CTM) and other documents. Communicate state and federal requirements to internal and external clients. Review and monitor new and updated laws and regulations, disseminating findings to key stakeholders accordingly. Participate on various compliance subcommittees and workgroups. Perform periodic compliance audits, risk assessments and conducts related ongoing compliance monitoring activities. Prepare analyses/reports based on audit results, including recommendations for corrective action; maintain records of audits and follow-up of corrective actions. Assist management in developing compliance audit instruments and protocols. Under leadership’s guidance, communicate with regulatory agencies to clarify requirements, address reporting and filing issues. Respond to external requests for information required by the organization for its regulatory filings; respond to inquiries from state and federal regulatory agencies. Assist in developing, producing and conducting compliance training programs. Assist affiliated and managed health plans in managing relationships with regulatory agencies and seek to resolve policy issues which may negatively impact service to members.

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