Work Remotely from Oregon, Washington, Idaho or Utah
Primary Job Purpose
As a member of the Compliance team, the Compliance Analyst is responsible to deliver an effective compliance program. They design, implement, deliver, measure and refine activities and controls to prevent, detect and correct violations of state, federal and other laws. Duties may include, but are not limited to, risk assessment, training, monitoring, auditing, external audit coordination, investigation, root cause analysis, regulatory implementation, control assessment, reporting, and corrective actions. Grade level at hire and upon promotion will be based on such factors as experience, performance, complexity and scope of work assigned, knowledge, and influence skills. This role may be specific to a product line or area, or may have a broader scope. Special projects may be assigned as needed.
We are seeking an individual with Medicare compliance experience to assist in prevention, detection, and remediation activities. Experience in risk adjustment compliance (Medicare and ACA) as well as a coding certification is preferred.
General Functions and Outcomes
Overall responsibilities include specific and/or portions of the following functions that relate to an effective compliance program utilizing as a basis the seven elements of compliance.
Duties include aspects of the preparation, planning, coordination, project management, submission, administration, monitoring and auditing of the Cambia compliance program which serves to oversee activities related to requirements, laws and regulations to prevent, detect and remediate compliance issues of the company.
Responsibility for producing and maintaining policies and desk manuals for position.
Works as a team with other staff members assigned in either a supporting or leading role.
Participating in the annual risk assessment process.
Ensuring materials, reports, and other documents are written in an understandable and concise style.
Project management and implementation.
Participating, supporting and serving in regular meetings, including divisional and cross-divisional committees as needed.
Core Competencies: risk assessments, training, policies and procedures, training, monitoring, auditing, root cause analysis, and corrective actions.
Additional Competencies: external audit coordination, implementations, control assessments, delegation oversight, data validation, marketing material oversight, DDE/FDR oversight.
Minimum Requirements (Compliance Analyst II and III)
Proven ability to deliver effective Core Compliance activities, including, monitoring, auditing, root cause analyses, and corrective actions.
Skilled in project management and delivery including proven ability to initiate and manage multiple projects and priorities.
Excellent written and oral communication and presentation skills.
Excellent research and analytics skills, with proven ability to distill actionable, practical advice from diverse sources and opinions. Legal research skills preferred.
Proven ability to influence effectively at all levels of the organization.
Excellent independent judgment and decision-making skills.
PC literate with office computer software - Word, Excel, PowerPoint, Outlook, Visio, etc.
Discretion and confidentiality.
Agile, with high learning velocity.
Demonstrated fluency in organizational agility: knowledgeable how about organizations work and how to get things done through formal and informal channels.
Practical familiarity with legal requirements relating to assigned compliance program, or for new hires, practical familiarity with analogous legal requirements.
Demonstrated mastery of at least four Compliance functions , to include the core competencies: risk assessments, training, policies and procedures, monitoring, auditing, external audit coordination, control assessments, reporting, corrective actions, implementation oversight, and ability to perform those compliance functions effectively within that compliance program; or if assigned to a specialized function (e.g. FDR/ DDE Compliance, Marketing Materials Review, Data Validations), mastery of all competencies related to that specialized function.
Demonstrated ability to handle successfully the most complex, most difficult matters end-to-end.
Demonstrated ability to drive success with the most challenging and/or most elevated partners.
Demonstrated mastery of legal requirements relating to assigned compliance program; or for new hires, demonstrated mastery of analogous legal requirements.
Demonstrated mastery of at least 6 core compliance functions, including the core competencies and ability to deftly perform all compliance functions relating to assigned compliance program as needed.
Demonstrated excellence in building effective relationships at all levels of the organization; influencing decision-making; effectively framing issues and dialogues; and driving successful outcomes.
Demonstrated, end-to-end operational knowledge relating to assigned compliance program.
Demonstrated peer mentoring and departmental leadership.
Normally to be proficient in the competencies listed above
Compliance Specialist II would have a Bachelor's degree or equivalent experience; 5 years of compliance experience or equivalent related experience, with experience in a health care or Medicare-regulated environment preferred.
Compliance Specialist III would have at least a Bachelor's degree or equivalent experience; 8 years of compliance experience or equivalent related experience, with experience in a health care or Medicare-regulated environment or ACA-regulated environment preferred.
Work Environment
Travel rarely required, locally or out of state.
May be required to work outside normal hours.
The expected hiring range for a Compliance Analyst II is $74,800.00 - $101,200.00 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 10%. The current full salary range for this role is $70,000.00 to $115,000.00.
The expected hiring range for a Compliance Analyst III is $91,000.00 - $123,100.00 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 15%. The current full salary range for this role is $85,000.00 to $140,000.00.
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About Cambia
Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.
Why Join the Cambia Team?
At Cambia, you can:
Work alongside diverse teams building cutting-edge solutions to transform health care.
Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
Grow your career with a company committed to helping you succeed.
Give back to your community by participating in Cambia-supported outreach programs.
Connect with colleagues who share similar interests and backgrounds through our employee resource groups.
We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.
In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:
Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
Annual employer contribution to a health savings account.
Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
Up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption).
Award-winning wellness programs that reward you for participation.
Employee Assistance Fund for those in need.
Commute and parking benefits.
Learn more about our benefits.
We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.
