Analista de Compliance at Tecnofit, ensuring regulatory alignment and effective KYC processes. Collaborating across teams to strengthen compliance culture and internal processes.
CA
Hybrid Operations Regulatory Specialist II – Health Plan Experience, Facets Preferred
Posted 5 months ago
About the role
- Operations Regulatory Specialist II providing support and leadership for regulatory compliance in healthcare operations. Partnering with departments to meet deliverables and resolving claims issues.
Responsibilities
- Provide analytical support and leadership for key internal Operations projects
- Partner with the Operations departments to ensure all regulatory and compliance deliverables are met
- Represent operations on cross-functional project work teams
- Submit, monitor and prioritize IT tickets for the operations departments
- Review special projects and identify issue trends and potential resolutions
- Assist with reporting and processes that are regulatory related and tied to state issues deadlines
- Assist with the development, drafting and review of P&P’s and job aides for Operations
- Assist in educating/training Business Partners on operations functions
- Research and resolve provider claim issues and escalations by analyzing system configuration, payment policy, and claims data when requested by Compliance
- Perform analysis of all claims data to provide decision support to Claims management team in relation to regulatory requests
- Identify and quantify data issues within Claims and assist in the development of plans to resolve data issues
- Partner and collaborate with Operations Business Owners to ensure all audit and regulatory deliverables are met accurately and on time
- Track and assist with remediation efforts for Corrective Action Plans related to all audit findings
- Ensure the timeliness submission of the Regulatory Reporting required by the state and federal agencies for Operations
- Track all Compliance required training on a yearly and new hire basis for Operations
- Assist with all readiness activities in relation to implementation of a new line of business for Operations
Requirements
- Bachelor’s degree or equivalent years of relevant work experience required
- Minimum of two (2) years of healthcare operations environment is required
- Regulatory and/or compliance experience is preferred
- Advanced level experience in Microsoft Word, Excel and PowerPoint
- Data analysis and trending skills
- Demonstrated understanding of claims operations specifically related to managed care
- Advanced knowledge of coding and billing processes, including CPT, ICD-9, ICD-10 and HCPCS coding
- Ability to work independently and within a team environment
- Attention to detail
- Familiarity of the healthcare field
- Critical listening and thinking skills
- Negotiation skills/experience
- Strong interpersonal skills
- Proper grammar usage
- Technical writing skills
- Time management skills
- Strong communication skills, both written and verbal
- Customer service orientation
- Decision making/problem solving skills
Benefits
- comprehensive total rewards package
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