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SC01124 - Compliance Analyst/Complaints - Miramar, FL #7039005

Company: Convey Health Solutions

Date: 11/19/2019

Category: Education / Training

City: Miramar, FL

ESSENTIAL DUTIES AND RESPONSIBILITIES


  • Manages the intake, analysis, review, and closure of all CTMs and Grievances pursuant to the compliance department procedures.
  • Partners with the Quality and Operational business units to assess, resolve, and mitigate complaints to Medicare.
  • Manages the intake, analysis, review, and closure of all government communications pursuant to the compliance department procedures.
  • Prepares fraud alert and OIG advisory opinion notices for the company and ensure accurate and timely communication/review with impacted business units.
  • Monitors assigned operations and partner with business unit leaders and team members on compliance and regulatory matters.
  • Partners with the compliance audit team to develop and monitor client and business unit specific remediation plans.
  • Manages compliance projects and provide regular reporting to business unit and compliance leadership teams.
  • Assist in monthly, quarterly, and annual reporting for client and internal business/account reviews.
  • Assists with reporting for the Executive Compliance Committee as assigned.
  • Assists with annual risk assessments at the direction of the Risk and Compliance Managers.
  • Assists with compliance trainings as assigned.
  • Other duties as may be assigned by the Compliance Management in alignment with the annual compliance work plan.

OTHER DUTIES AND RESPONSIBILITIES


  • Ensures adequate documentation is maintained.
  • Performs regulatory research to assist in the assessment of compliance related questions and matters.
  • Prepares objective, accurate and factual formal and informal reports summarizing compliance matters and determining effect and risk.
  • Identifies, analyzes and assesses complex enterprise-wide environment, regulatory compliance inquiries and issues, and compliance program needs.
  • Recommends compliance programming, compliance initiatives and internal departmental controls.
  • Assures appropriate implementation and/or corrective action is taken to address risks and issues identified.
  • Communicates work product that meets professional, ethical and audit standards for clarity and completeness.
  • Coordinates compliance data needs for operational departments, to include collection, trending and analysis to identify compliance and areas of risk.
  • Meets regularly with operational departments to review data analysis and assist in the execution and monitoring of corrective measures.
  • Assists the Director of Compliance and Regulatory Affairs or designee with developing and publishing compliance and internal control tools and guidance for internal employees and sub-contractors as required by the contract, and any applicable Federal, State and Local rules and regulations.

REPORTING RELATIONSHIP


__ This position has no supervisory responsibilities


Provides work direction only Provides work direction plus has responsibility for hiring, promotions, transfers, performance management, discipline and discharge, etc.


JOB REQUIREMENTS


Education and Experience


  • Bachelor's degree in Business or Healthcare required.
  • 3+ years of experience in data analysis, compliance auditing, program evaluation, management or policy analysis, and/or,
  • 3+ years of experience conducting data analysis, health plan operations, compliance and performance auditing for a health plan.
  • Knowledge of and experience with the monitoring and tracking of government communications to include Health Plan Management System (HPMS) Memos, OIG Fraud Alerts and Advisory Opinions, and Federal Register and PRA Publications.
  • Experience with health plan grievance processes and CTMs preferred.

Knowledge, Skills, and Abilities:


  • Demonstrates strong leadership abilities.
  • Supports colleagues and values others contributions.
  • Fosters an efficient, innovative and team-oriented work environment.
  • Knowledge of Medicare and Medicaid contractual requirements, health plan data analysis, audit processes, internal auditing, healthcare, and operation, preferred.
  • High level of personal and professional integrity and confidentiality.
  • Significant knowledge of operational processes, efficient and effective workflows, and best practices in a managed care organization.
  • Familiarity with all phases of an audit including planning, analysis, report writing corrective action plan development, and follow up education.
  • Ability to work independently and effectively work with team members at all levels.
  • Excellent research and analytical skills.
  • Ability to manage multiple projects, including establishing deadlines for individual assignments as well as Compliance team deadlines.
  • Ability to provide constructive feedback via work paper review and formal/informal education.
  • Ability to deal with many functional areas of a national organization.
  • Ability to identify processing/policy issues as they apply to corporate and contract standards.
  • Strong written, verbal and interpersonal communication skills are required
  • Proficient in Microsoft Office Product Suite.

WORK ENVIRONMENT


  • Tasks involve the ability to perform the duties and responsibilities noted above.
  • Most tasks are performed in a standard office environment; however, when not in the office environment, tasks may be regularly performed with exposure to adverse environmental conditions, such as dirt, dust, pollen, odors, wetness, humidity, rain, snow, fumes, heights, temperature extremes, noise extremes, machinery, vibrations, electric currents, traffic hazards, explosive hazards, toxic agents, radiation, disease, pathogenic substances, vermin or insect infestation, violence, gang or criminal activity.
  • The normal work routine involves no exposure to blood, body fluids, or tissues (although any work environment presents some small risk of exposure to body fluids). Individuals who perform these duties are not called upon as part of their employment to perform or assist in emergency medical care or first aid. The normal work routine may involve tasks that involve handling implements or utensils, the use of public or shared bathroom facilities or telephone and personal contacts such as handshaking.

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled


Convey Health Solutions, Inc.


Miramar


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