Configuration QA Analyst - Compliance

$77,022 - $115,544/Yr

Summa Health System - Akron, OH

Full-time - Mid Level

Akron, OH

Hospitals

About the position

The Configuration QA Analyst - Compliance at SummaCare is responsible for ensuring compliance with corporate, departmental, and regulatory standards within the healthcare environment. This role involves auditing and monitoring configuration products and procedures, managing corrective action plans, and collaborating with management to recommend improvements based on compliance outcomes. The analyst will utilize their expertise in regulatory guidance and data analysis to support the organization's commitment to high-quality health insurance services.

Responsibilities

• Maintain current understanding of applicable corporate, departmental, state DOIs, CMS and ERISA regulations.
• Conduct auditing and monitoring of configuration products and procedures to ensure compliance with policies and regulations.
• Complete universes and scorecards for related measures, reviewing outcomes with management and recommending corrective actions for continuous improvement.
• Manage the Corrective Action Plan (CAP) process for the department to ensure timely resolution of compliance concerns.

Requirements

• Bachelor's degree in a business, legal/regulatory, or healthcare-related field or equivalent combination of education and/or experience.
• Three years of experience in configuration within a managed care or healthcare environment, health plan auditing, project management, or compliance/regulatory program administration.
• Proficiency in Microsoft Office, particularly Word and Excel at an intermediate level, including the ability to create macros.
• Experience with Microsoft SQL Server Management Studio is strongly desired.

Nice-to-haves

• Experience with Medicare or Marketplace programs.
• Strong analytical skills to review regulatory guidance and create action plans for implementation of new and changing rules.
• Excellent proofreading skills and attention to detail.

Benefits

• Health insurance