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Senior Analyst, Regulatory Compliance in Southfield, MI at AF Group

Date Posted: 11/29/2018

Job Snapshot

Job Description



SUMMARY:

Regulatory Oversight Senior Analysts are responsible for leading and/or supporting processes that ensure oversight and ongoing monitoring of Blue Cross Blue Shield of Michigan (BCBSM) Medicare Advantage and Part D programs. Interface with external customers, including regulatory agencies and professional associations, internal customers and vendors to identify and/or analyze business problems and develop solutions is required.



RESPONSIBILITIES/TASKS:

  • Ability to navigate and effectively interpret regulations and rules in accordance with the CMS Manual System and BCBSA guidelines.
  • Develop and improve work flows and business processes within process area(s) to improve controls and overall quality.
  • Assist with implementing and reviewing standard policies and procedures to ensure compliance with CMS regulations.
  • Research, analyze, and disseminate CMS guidance and communications to MA internal and external stakeholders
  • Identify, analyze, and track compliance risks and deficiencies.
  • Review corrective action plans to ensure remediation leads to effective, compliant resolution.
  • Review evidence submitted by vendors (FDR) to determine compliance with Medicare regulations.
  • Participate in development and implementation of new procedures/controls.
  • Provide recommendations for ongoing improvement of core processes.
  • Assists personnel (both internal and external) by answering questions, supplying information, and training, as appropriate.
  • Assists in the development, coordination, and implementation of methods and procedures to ensure that all sales, marketing, promotion, and operational documents and activities are compliant with CMS deadlines and regulations.
  • Writes, revises, and maintains documents related to the sale and marketing of Medicare Advantage products and submit the materials for approval through the CMS, within the mandated deadlines.
  • Facilitates CMS review of materials through research and investigation of the questions raised by and requests made by CMS.
  • Develop and maintain an effective working relationship with customers.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.