Conducts audits to ensure compliance with federal and state requirements. Educational Requirements. Bachelor Degree or may substitute with 4 years of like experience. Required Experience 4 years performing same or similar responsibilities. Relevant experience includes any combination of the following: health plan operational experience, compliance administration, auditing, working knowledge of Medicare and/or Marketplace requirements, and data analysis. Required Licenses and/or Certificates. Non... more details
Compliance Analyst
SummaCare - 1200 E Market St, Akron, OH
Full-Time / 40 Hours / Days
Hybrid / Remote
SummaCare is a Summa Health entity that offers health insurance in northern Ohio. As a regional, provider-owned health plan, SummaCare is based in Akron, Ohio, and provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2024 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits.
Summary:
Conducts audits to ensure compliance with federal and state requirements.
Educational Requirements
Bachelor Degree or may substitute with 4 years of like experience.
Required Experience
4+ years performing same or similar responsibilities. Relevant experience includes any combination of the following: health plan operational experience, compliance administration, auditing, working knowledge of Medicare and/or Marketplace requirements, and data analysis.
Required Licenses and/or Certificates
None required.
Software and Data Etnry Requirement
None Required.
SKILLS AND ABILITIES
Communication
Complex: ability to communicate complex information verbally and in written form that may include policies and procedures, financial, legal, and/or technical documents, and opinion papers; ability to provide guidance required to implement strategic programs and projects; ability to supervise work within and/or across departments; ability to negotiate and persuade professionals, board members, and general public.
Analytical
Highly Complex: designing, developing, implementing highly complex programs, products, technical systems, policies that affect overall direction of the company. Proofreading completed work to find and correct errors. Requires excellent attention to detail.
Other Skills and Abilities
1. Demonstrate leadership skills including ability to influence action of others not directly reporting to him/her.
2. Read, analyze, and interpret general business periodicals, professional journals, technical procedures, and government regulations.
3. Apply principles of logical thinking to define problems, collect data, establish facts, draw valid conclusions, and prepare recommendations.
4. Interface with staff at all levels.
5. Organize and manage time to accurately complete tasks within designated time frames in fast-paced environment.
6. Maintain current knowledge of and comply with regulatory and company policies & procedures.
7. Maintain confidentiality of patient and business information.
8. Flexible: ability to adjust work hours to meet business demands.
Physical Effort and Dexterity*
1. Sit for prolonged periods of time.
2. Bend, stoop, and stretch.
3. Lift up to 20 pounds.
4. Manual dexterity to operate computer, phone, and standard office machines.
Visual Acuity, Hearing, and Speaking*
* Candidates whose disabilities make them unable to meet these requirements will still be considered fully qualified if they can perform essential functions of job with reasonable accommodation.
Scheduling
Frequent overtime work required during peak business periods as scheduled by supervisor. Occasional travel which may require use of personal auto to attend meetings, conferences, workshops, and/or seminars.
Safety Hazards and Environment
Minimal hazards. General office working conditions.
$27.82/hr - $41.73/hr
The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical.
