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Company

Original Job Post

Community Health Group · 1 week ago

Compliance Analyst

Chula Vista, CA

Full-time

Onsite

Mid Level

2+ years exp

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Hiring Manager

Alejandra Santana

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Responsibilities

Implements and maintains established audit/control systems and policies and procedures.

Plans, organizes and coordinates various projects and programs involving statutory, regulatory, and quantitative impact of legislation and rule-making.

Assists in development of corporate training program related to policy and legislative matters on an as needed basis.

Assists in the management of day-to-day operations of the compliance program.

Monitors, and as necessary, coordinates compliance activities of other departments to remain abreast of the status of all compliance activities and to identify trends.

Provides reports on a regular basis, and as directed or requested, keeps the Compliance Officer, Compliance Manager and Compliance Committee informed of the operation and progress of compliance efforts.

Assists in the monitoring of the Compliance Program and related activities on a continuing basis.

Under direction of the Compliance Officer and Compliance Manager, assists in the coordination of communication and audits with regulatory agencies.

Provides staff support to committees or other departments, as assigned.

Documents and maintains records of all audits performed. Records include raw data or files reviewed, report of findings, corrective action plans, reassessment, and any ongoing monitoring logs.

Investigates, reviews, and analyzes claims data by applying knowledge of established policy, practice and by data mining techniques to determine details of fraudulent erroneous, or abusive billing activity.

Produces a written report to summarize audit scope and findings and recommended corrective action.

Reports any audit concerns to Compliance management without delay.

Provides departmental education and training.

Reassess a deficiency after a corrective action has been implemented and conducts on-going monitoring to ensure that deficiency does not reoccur.

Oversees any monitoring functions that may be conducted by other department team members included but not limited to, monitoring for fraud, waste, and abuse.

In concert with Compliance management, prepares documents for any external or internal audits.

Assists in the development of new audit methodology and scope on an as-needed basis.

Keep up-to-date with State and Federal regulations that apply to the organization.

Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.

Contributes to the team effort by accomplishing related results as needed.

Maintains product and company reputation and contributes to the team effort by conveying professional image and accomplishing related tasks; participating on committees and in meetings; performing other duties as assigned or requested.

Performs other duties as assigned.

Qualification

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AuditingComplianceLegislative affairsRegulatory affairsPublic policy analysisManaged careMicrosoft WordExcelPowerPointOutlookFederal regulationsState regulationsLocal regulationsInternal auditingProblem-solvingAnalyticalOrganizationalVerbal communicationWritten communication

Required

Bachelors Degree Preferred

Two or more years experience in auditing, compliance, legislative affairs, regulatory affairs, or public policy analysis preferred

Two or more years in managed care setting

Advanced knowledge of Microsoft Word, Excel, PowerPoint and Outlook

Customer service skills with the ability to interact professionally and effectively with staff from all departments within and outside the Company. Excellent verbal, written, organizational, and analytical skills

Understanding of federal, State, and local legislative and regulatory processes

Ability to handle confidential, sensitive information with professionalism

Must have a track record of producing work that is highly accurate, demonstrates attention to detail, and reflects well on the organization

Demonstrated ability to utilize and apply internal auditing principles, practices, and techniques

Ability to organize and prioritize work effectively; detail oriented; apply established policies procedures and guidelines for problem-solving and decision making