Insurance Compliance Analyst

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November 13

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Peak Health

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Healthcare Insurance • Non-profit

Peak Health is a health insurer and health insurance services company headquartered in Morgantown, West Virginia. It is owned by three not-for-profit health care providers: WVU Health System, Marshall Health Network, and Valley Health. Peak Health aims to improve community health outcomes by offering an inclusive, provider-led health plan for residents of West Virginia and surrounding areas. The company is committed to making health care more accessible, understandable, and collaborative, with a focus on reducing costs and administrative fees for patients and employers. Peak Health also offers Medicare Advantage coverage tailored for West Virginia seniors through partnerships with leading health systems.

51 - 200 employees

⚕️ Healthcare Insurance

🤝 Non-profit

📋 Description

• Participate in and support compliance program activities including monitoring, investigations, exclusion screenings, policy preparation, communications, and training. • Lead the compilation, tracking and reporting of deliverables; review deliverables for accuracy and facilitate corrections. • Assist with vendor activities, including documentation of all pre- and annual delegate oversight and ongoing vendor oversight activities. • Assist with compliance audits and related activities, including tracking documentation, coordination of interviews, and support the preparation of final reports. • Provide analysis, interpretation, training, and education related to requirements as needed to ensure understanding and effective implementation of compliance requirements. • Support operational partnerships to ensure compliance with applicable rules and regulations, while supporting a positive member experience. • Develop and implement process improvement and automation for Compliance Department. • Investigate issues with effective research, root cause analysis, and gap analysis for effective remediation and corrective action management. • Maintain and enhance current knowledge of compliance and best practices through attendance of meetings and seminars, study of reference materials, and updates to compliance rules and regulations.

🎯 Requirements

• Bachelor’s Degree in healthcare administration, compliance, paralegal studies, business administration, or related field • Two (2) years of health care compliance experience • Two (2) years of health care regulatory experience • Certified in Healthcare Compliance (CHC) preferred • Understanding of compliance requirements for Medicare, Medicaid, and Commercial Lines of Business • CPA or audit and investigation experience is a plus • Analyzing and communicating regulatory requirements

🏖️ Benefits

• Health insurance • Paid time off • Professional development opportunities