*POSITION SUMMARY:* Supports the Corporate Integrity program through the facilitation and administration of compliance activities related to the operation of the compliance program. Performs regulatory reviews, data analysis and investigations, tracks and analyzes compliance activities. *PRIMARY ACCOUNTABILITIES:* 1. Coordinate filing of regulatory submissions, reports, materials and assists other departments in understanding and complying with regulatory requirements. 2. Track all issues/potential risks submitted to the regulatory integrity team including and up to resolution. 3. Support management of the regulatory communications process ensuring all regulatory communications and updates are received, summarized, documented and acted upon. 4. Lead the maintenance, execution and documentation of the annual corporate integrity plan. 5. Conduct or facilitate performance of reviews and investigations, including design and documentation of the review/investigatory methodology. Identifies potential compliance concerns, conducts data mining/analysis, regulatory risk reviews and investigations to confirm or refute concern, and quantifies the potential impact. 6. Perform data collection and analysis for investigations of potential compliance issues and for other compliance activities such as conflict of interest disclosures, risk assessments, surveys, responses to regulatory audits, compliance related lawsuits, etc. 7. Use analytical review, computer analytics and statistical sampling techniques to identify compliance risk areas. 8. Collaborate with various departments to obtain information needed in conducting risk reviews, risk assessments, and investigations. Provides result feedback summary reports to appropriate leadership and key stakeholders. 9. Recommend remediation plans and risk mitigation plans in response to investigative findings and/or review results. 10. Partner with department leadership to establish compliance monitors and reports as needed. Provides feedback and education to providers, staff and leaders throughout the organization on the results of reviews, investigations, and monitoring activities. 11. Prepare quarterly reports for corporate integrity committees regarding the compliance review activities and actions taken and creates reports for regulatory agencies as directed. 12. Develop department policies, procedures and tools for effective data mining, implementation of compliance reviews and risk reviews, and investigation plans and reporting of results. 13. Manage special and complex project work, researching key project components and designing the internal/review process and corresponding documentation. 14. Function as a knowledgeable resource for identifying current and ongoing changes to applicable laws, rules, regulations and policies related to compliance activities. 15. Train new staff on data mining, auditing and investigation processes, and develop educational tools to promote efficiency and accuracy. *MINIMUM QUALIFICATIONS* * Education: Bachelor’s Degree * Licensure: None * Certification: None * Work Experience: 3 years of documented health plan regulatory experience * Work Experience of lieu of Education: High School Diploma or equivalent and additional two years of health plan regulatory experience * Knowledge/Skills/Abilities: o Highly motivated, team oriented, professional, and trustworthy with strong skills inprofessional diplomacy. o Demonstrated ability to handle sensitive communications with leadership, physicians, management, and legal counsel. o Strong organizational and time management skills. o Demonstrated proficiency in Microsoft Office (Word, Excel, Powerpoint and Sharepoint) or similar products. o Note: This position may have the ability to work remotely for the majority of the role after successful completion of the orientation period. *PREFERRED QUALIFICATIONS* * Education: No additional * Licensure: None * Certification: None * Work Experience: N/A * Knowledge/Skills/Abilities: No additional *PHYSICAL REQUIREMENTS *Sedentary – Office Workers * Sedentary work involves sitting most of the time. * Walking and standing or lifting more than 10 pounds are required only occasionally. * Must be able to tolerate long periods of computer time a day. * Manual hand and wrist dexterity. * Occasional travel to other Health First sites. **Job:** **Integrity* **Organization:** **HF Administrative Plan Inc* **Title:** *Regulatory Integrity Analyst - Health Plans Corporate Integrity* **Location:** *Florida - Brevard County-Rockledge* **Requisition ID:** *075437*