Altius Health Plans is an organization of people dedicated to serving the health care needs of our community. We foster team involvement, encourage continuing education, and reward success. At Altius Health Plans, we strive to maintain an organization with energetic, growth-minded, and loyal employees who are continually challenged to make a difference.
Join a team that offers the family feel of a local organization with the support and resources of a Fortune 500 company! We offer a competitive salary, a comprehensive benefits package, tuition reimbursement, and a 401(k) plan with company match and immediate vesting, and excellent growth opportunities.
GENERAL SUMMARY
Collaborates with Compliance Department and
- Maintains an awareness of trends, developments and governmental regulations in health care and managed health care organizations.
- Analyzes and interprets existing and proposed legislation and regulations and determines their effects to the Company.
- Drafts responses to proposed laws and regulations and serves as a resource to staff for review and implementation of benefit and policy statements.
- Prepares, drafts, and files plan certificates of coverage and any other information required by the federal and state agencies.
- May assist in developing risk assessments to identify required audit areas and audit frequency.
- May conduct internal audits to assess compliance with company policies, state and federal laws and regulations.
- May conduct external on-site audits to assess compliance with Administrative Services Provider Contract (ASPC) and Third Party Administrator (TPA) laws and regulations.
- May develop audit reports to identify areas of noncompliance, propose recommendations and obtain responses and corrective action plans from the head of the functional area.
- May monitor the implementation of state and federal laws and regulations. Conducts appropriate reviews to ensure policies and procedures comply with enacted laws and regulations.
- May conduct training regarding company policies and procedures. Provides training on security of personal health information (PHI), Anti-Fraud, HIPAA requirements, and other compliance related topics.
- Performs other duties as required.
Qualifications:
- Bachelor’s degree or equivalent experience.
- Previous (3-5 years) insurance and HMO regulatory compliance.
- Previous experience with internal auditing functions.
- Excellent organizational and interpersonal skills.
- Strong analytical and problem solving skills.
- Demonstrated verbal and written communication skills.
- Proficient with standard PC applications.
Altius Health Plans is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: South Jordan, UT, US
Organization: 30000 - Altius Health Plans
Schedule: Full-time
Job Posting: 2013-01-15 00:00:00.0
Job ID: 1310171