Compliance Analyst

Compliance Analyst Pasadena CA Direct Hire

Salary : $73000$77000

Schedule : On-site

Openings : 3

Overview

We are seeking three Compliance Analysts with CMS regulatory compliance experience in a Medicare Advantage Prescription Drug (MAPD) environment. Ideal candidates have strong auditing skills across Claims UM and CR operations with a clear understanding of federal regulatory requirements.

Key Responsibilities

• Conduct regulatory audits of Claims UM and CR functions to ensure compliance with CMS Medicare Advantage & Part D requirements.
• Interpret and communicate CMS regulatory updates manuals and operational guidance.
• Perform internal monitoring issue tracking corrective action follow-up and support FWA (Fraud Waste & Abuse) prevention activities.
• Provide regulatory guidance to internal departments and external partners.
• Participate in CMS trainings / webinars as needed.
• Perform CMS data submission quality checks and assist in preparation for CMS reviews and audit activities.
• Support oversight of first tier downstream and related entities (FDRs).

Required Experience

CMS Medicare Managed Care Manuals / Part C & D

Skills & Attributes

Preferred

Required Experience :

IC

Key Skills

Abinitio,Apprentice,Dermatology,Cost Estimation,Data Networking,Liaison

Employment Type : Full Time

Experience : years

Vacancy : 1

Monthly Salary Salary : 73000 - 77000