Senior Compliance Analyst - Dentaquest

Senior Compliance Analyst – Dentaquest

Bachelor’s degree is required
3+ years of experience in compliance, legal or regulatory functions
1+ years of health care or insurance benefits experience
Working knowledge of HIPAA, Medicare/Medicaid, and commercial insurance regulations
Ability to attend additional training as requested/deemed necessary
Ability to attend in-person regulatory meetings with clients
Ability to evaluate laws and regulations and identify and prioritize relevant content for updating policies and procedures
Ability to interpret laws and regulations and communicate that information to management and line personnel
Ability to research and investigate regulatory issues as they relate to the company’s operating subsidiaries and businesses
Ability to discern risks and recommend controls to mitigate regulatory compliance
Ability to assume a reasonable level of authority, to handle multiple projects and duties at the same time and to work collaboratively in a non-hierarchical department structure
Ability to interface with various levels of management, as well as with internal and external clients and subject matter experts
Strong writing skills, with extensive policy and procedure writing experience required
Strong verbal communication skills
Strong collaborative skills, as well as analytical, problem-solving and decision-making skills
Meticulous organizational skills and attention to detail

Assist with review and update of annual Program Integrity Compliance Plans for State Medicaid Clients
Partner with Fraud Prevention and Recovery (Special Investigations Unit – SIU) to develop content for Program Integrity Compliance Plans
Assist with the management and review of entity disclosure of ownership and control interest information to State Agencies
Partner with Fraud Prevention and Recovery to conduct necessary investigations and follow-up of any compliance reports or related complaints
Collaborate with Legal to provide focused interpretation and guidance regarding legislation and regulations to advance the growth, innovation, and performance goals of the program to cross functional teams
Work with Operations to prevent improper payments, such as ensuring no payments to prohibited providers, entities, and individuals
Provide comprehensive and thorough responses to client inquiries regarding a range of topics covering operational processes such as utilization management to offering assistance on best practices for auditing protocols