42 applicants

Overview

Company

Original Job Post

CalOptima · 3 days ago

Regulatory Affairs & Compliance Analyst

Parkway, CA

Full-time

Hybrid

Entry, Mid Level

$68K/yr - $109K/yr

2+ years exp

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GovernmentHealth Care

Comp. & Benefits

Insider Connection @CalOptima

Discover valuable connections within the company who might provide insights and potential referrals, giving your job application an inside edge.

Responsibilities

Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity, and accountability.

Performs investigations from referrals by internal and external sources, including the Compliance hotline.

Conducts risk assessments, maintains accurate documentation, and completes investigations within required timeframes.

Monitors compliance with regulatory requirements and issues corrective action plans when deficiencies are identified.

Helps with developing and delivering FWA related training materials.

Aids in the maintenance of FWA related databases, tracking tools, and auditing tools.

Conducts research and provides guidance to internal departments relating to FWA issues.

Utilizes data analytic software to identify abnormal billing and utilization patterns.

Prepares claim information, reviews data, and initiates recovery process for improperly paid claims.

Prepares summaries and reports on FWA cases for referral to regulatory agencies and on investigations for Compliance committee and Board reports.

Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.

Assists with the preparation efforts for regulatory audits.

Assists with reviewing and revising FWA policies and procedures, templates, and forms in coordination with management and administration.

Completes other projects and duties as assigned.

Qualification

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Managed Care Delivery SystemsRoot Cause AnalysisData AnalysisMedical BillingCodingMedical TerminologyClinical Documentation GuidelinesProblem-SolvingAnalytical Thinking

Required

Bachelor’s degree in health care administration, public health, public administration, public policy or related field required.

2 years of experience in managed care delivery systems required.

An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.