Experience:
3-5 years of experience
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Employment Type:
Full time
Posted:
6/17/2016
Job Category:
Administration
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Compliance Analyst, Program Accreditation- Woodland Hills
Health Net, Inc. | Woodland Hills, California
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Job Description

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Job Summary

Under general supervision, the Compliance Analyst reviews and analyzes new and existing accreditation standards, laws, regulations and policies for their impact on supported Health Plans. This position monitors and helps to ensure compliance with regulations in accordance with the specific areas they support. Educates Health Plan associates on regulatory, accreditation and/or legal issues.

Essential Duties & Responsibilities

  • Reviews and monitors policies and procedures to ensure compliance with accreditation regulations. May help draft policies and procedures in response to changes and updates of specific accreditation standards, laws and regulations.
  • Assists with the implementation of new policies and procedures that affect compliance with accreditation.
  • Researches and analyzes accreditation and regulatory requirements as needed to ensure compliance.
  • Interprets regulations regarding benefits and provides information and education to Health Plan associates.
  • Monitors compliance in regards to accreditation/regulatory related communications including training and manuals.
  • Assists with informing management and Health Plan associates of changes or updates to accreditation/regulatory requirements.
  • Assists in the coordination of responses for Corrective Action Plans, inquiries, follow-up, reporting and any other requests.
  • Assist in the preparation of materials and requirements for accreditation and regulatory audits.
  • May act as subject matter expert in reviews of Request for Proposals (“RFPs”) and non-standard contracts with large employer groups.

Education

 

  • Bachelor's Degree in Business, Health Administration, or related field

 

Government Clearance & US Citizenship Requirement

Proof of U.S. Citizenship is required.

Experience Required

  • Three years experience in compliance-related field, preferably in healthcare
  • Three to five years experience in the area the position provides support
  • Knowledge, Skills & Abilities

     

    • Knowledge of National Committee for Quality Assurance (NCQA) standards, laws, regulations, and related matters relevant to the operations of Health Plans and the Company
    • Strong analytical and problem-solving skills, customer focus, and expeditious follow-up skills
    • Outstanding communication skills including excellent verbal, written, and presentation abilities
    • Ability to prioritize and multi-task while paying attention to detail and meeting tight deadlines
    • Proficiency with computer and standard business software (i.e. Word, Excel, and Power Point) and the ability to learn in-house and other systems quickly with minimal training
    • Possess a high level of motivation and professionalism and demonstrate ethical conduct and good judgment at all times while conducting Company business

     

    Working Conditions

     

    The following section describes the general physical requirements for this position. Please note that constant refers to more than 81% of time; significant refers to 40-80%; and moderate refers to 20-40% of the time.

    • Operates personal computers, printers, facsimile, telephones, copy machines and other commonly used office accessories/equipment. (Constant)
    • Exposed to confidential information and expected to maintain confidentiality at all times; must adhere to HIPAA rules and regulations. (Significant)
    • May be required to work outside of normally scheduled hours as mandated by the client, project and/or workload (e.g. evenings, weekends, and/or holidays). (Moderate)
    • May be required to maintain established work pace, meet deadlines; may have last minute urgent requests. (Significant)
    • Physical activity may include: twisting, reaching, kneeling, bending, stooping, squatting, crawling, grasping, grabbing, pushing, pulling, repetitive motion, climbing, etc. (Moderate)
    • Required to have visual acuity to determine the accuracy, neatness, and thoroughness of the work assigned. (Constant)
    • Required to have hearing ability to receive detailed information through oral communication. (Constant)
    • Required to have speaking ability to express or exchange ideas. (Constant)
    • Constant concentration may be required on various subjects by listening, reading and thinking clearly.
    • Interaction with others may be required. May need to listen, think, and speak in order to interact with others. Business interactions and behavior between coworkers and/or external customers are required. This may require face-to-face or telephone interactions. (Constant)
    • Thinking at work may include listening, learning, analyzing, evaluating, and the ability to interpret what is seen and/or heard, or to link information from one issue to the next. (Constant)
    • Constant computer usage including typing and/or eye strain.
    • Constant repetitive arm, wrist, hand and finger motions -- making repetitive movements (e.g. key boarding, filing, data entry).
    • Moderate phone usage; headsets may be required.
    • Constant sedentary work (desk bound or seated).
    • Constant reading is required via computer screen and/or bound printed materials.
    • OR
    • Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.

     

    Disclaimer

    DISCLAIMER: The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this job. They are not intended to be construed as an exhaustive list of responsibilities, duties and skills required of personnel so classified.

    Location:

    Health Net and its subsidiaries are an Equal Opportunity/Affirmative Action Employer - Minorities/Females/Veterans/Disability

     

     

    About Health Net, Inc.

    Health Net, Inc. (Health Net) is an integrated managed care organization that delivers managed healthcare services through health plans and government-sponsored, managed-care plans. The Company operates and conducts its businesses through its subsidiaries. Health Net's health plans and government contracts subsidiaries provide health benefits through its health maintenance organizations (HMOs), insured preferred provider organizations (PPOs) and point-of-service (POS) plans to approximately 6.7 million individuals across the country through group, individual, Medicare, (including the Medicare prescription drug benefit commonly referred to as Part D), Medicaid, TRICARE and Veterans Affairs programs. The Company operates within two segments: Health Plan Services and Government Contracts. (Source: 10-K)

    This company profile was created by AfterCollege and is about Health Net, Inc.. This page is not endorsed by or affiliated with Health Net, Inc.. For questions regarding company profiles, please email: care@aftercollege.com.