Regulatory Compliance Associate

Regulatory Compliance Associate

Requirements

• High School Diploma/GED required.
• Bachelor degree preferred or relevant experience in lieu of degree.
• Requires a minimum of five (5) years of relevant compliance experience in a healthcare or managed care environment.
• Requires a minimum of three (3) years experience in the interpretation and application of federal and state regulations, policies and procedures, and ethical principles related to healthcare compliance.

Responsibilities

• Maintain knowledge of all relevant legislative and regulatory health plan requirements and monitor information sources for changes in regulatory compliance program requirements for Horizon’s LOBs.
• Analyze information and determine what is informational versus change affecting organizational processes.
• Review, interpret, summarize and communicate new and revised requirements to the business unit personnel using multiple distribution methods.
• Provide plain language compliance guidance and direction to operationalize regulatory compliance requirements and support implementation of changes stemming from new or revised State and Federal requirements.
• Oversee compliance with new, revised, and pending regulatory requirements through the Requirements Database, and collect and evaluate evidence of compliance submissions from business unit personnel.
• Support and actively participate in annual team functions including monitoring, ongoing risk assessment, audit readiness activities, external audit coordination, executing the compliance workplan, and other divisional priorities related to risk mitigation.
• Gather relevant data and Key Performance Indicators for compliance reports and dashboards, and prepare reports based on established reporting metrics for the group.
• Independently investigate areas of non-compliance, and act on matters by designing and coordinating internal investigations and resulting corrective action plans with all departments.
• Identify potential non-compliance vulnerabilities and make practical business recommendations to correct non-compliance or improve insufficient processes.
• Monitor business units’ self-monitoring results to ensure that current procedures satisfy regulatory requirements and are sufficient to detect future instances of non-compliance. Assist with the development of compliance policies, control processes, self-monitoring, and self-auditing tools that promote maintaining compliant business processes.
• Develop and update Standard Operating Policies and Procedures (SOP) for review processes and compliance. Educate stakeholders on these SOPs.
• Develop collaborative relationships with regulators. Monitor compliance related commitments made to regulatory agencies governing Horizon’s LOBs, and review and maintain submissions, reports, and filings to regulators.

Preferred Qualifications

• Certified Compliance & Ethics Professional Certification (CCEP) – Compliance Certification Board
• Certified in Healthcare Compliance (CHC) – Compliance Certification Board
• Leadership Professional in Ethics & Compliance (LPEC) – Ethics and Compliance Institute