Compliance Analyst II

The primary purpose of the Compliance Analyst II position is to support the implementation and management of the Compliance Program. This position executes activities that ensure Alliance operations are compliant with applicable laws, regulations and standards, ethical business practices and documented procedures. This position requires management of multiple projects, deadlines and outcomes. This position works with cross-functional teams, participates in gathering, documenting, and reporting compliance metrics.

This position will allow the successful candidate to work a schedule which will include both onsite as well as remote work certain days of the week as approved by their supervisor.

Responsibilities and Duties

• Maintain knowledge of complex healthcare regulatory issues, including fraud and abuse, privacy and security, Medicaid participation, access to care, grievances and appeals, and other managed care regulatory issues.
• Maintain an inventory of all internal and external requirements and monitor for changes in current laws and regulations.
• Provide assistance with policy interpretation.
• Act as a compliance liaison for operational initiatives, pilots and projects to define compliance requirements, provide guidance and facilitate solutions to complex compliance issues.
• Conduct compliance audits and monitoring of Alliance operations to ensure compliance with the law, contractual obligations and Alliance policies and procedures, in accordance with the annual compliance and audit work plans.
• Monitor compliance with Tailored Plan Contract Attachment P. Performance Metrics, Service Level Agreements, and Liquidated Damages to determine compliance and avoid penalties. Work with departments on development and monitoring of remediation plans.
• Coordinate delegation oversight activities to ensure compliance with the Alliance Delegation Program Description and Operating Plan. Gather data from responsible departments.
• Track delegation oversight activities and metrics, prepare reports for internal committees and NCDHHS.
• Develop and prepare reports of factual observations, findings and recommendation designed to strengthen internal controls or improve operational procedures.
• Conduct compliance investigations, documents findings, and presents results to the Director of Corporate Compliance. Track follow-up actions to completion and monitor for trends.
• Monitor operational departments’ implementation and compliance with corrective action plans and report progress and results to Director of Corporate Compliance.
• Maintain records of assigned inquiries and track research and disposition of compliance issues raised by senior management, employees, business partners and external auditors.
• Participate in the development of and facilitate Corporate Compliance trainings, education or communication to internal departments and network providers.
• Maintain reporting related to adherence to training requirements and effectiveness of training efforts.

Minimum Requirements

Bachelor’s degree from an accredited college or university in healthcare, business administration, public policy, or related field and a minimum of seven (7) years’ experience in health care, compliance, auditing, regulatory or law, or any equivalent combination of related training and experience. One (1) to three (3) years previous healthcare compliance related experience, preferably with demonstrated skill in compliance auditing and investigations.

Preferred Certifications

Certified in Healthcare Compliance (CHC); Certified Compliance and Ethics Professional (CCEP); Certified in Healthcare Privacy Compliance (CHPC); Certified Fraud Examiner (CFE); Accredited Healthcare Fraud Investigator (AHFI); Certified Internal Auditor (CIA); or other similar professional certification

Knowledge, Skills, and Abilities

• Possess knowledge of state statutes and federal regulations applicable to Medicaid managed care, local government, HIPAA Privacy and Security, healthcare fraud, waste, and abuse, and other healthcare regulations.
• Demonstrated understanding of all major managed care functions.
• Ability to maintain confidentiality and handle highly sensitive information with discretion.
• Ability to establish and maintain positive and effective working relationships with others.
• Ability to provide effective consultation, education and training to others.
• Excellent verbal and written communication.
• Possess excellent decision-making abilities and judgment to determine the appropriate courses of action and subsequent follow-up.
• Ability to understand and interpret complicated written material and verbal presentations.
• Excellent time management skills and ability to adapt and alternating focus between tasks as dictated by business needs.
• Demonstrated knowledge of investigative techniques and methods.
• Proficiency in advanced function of Microsoft Office Excel and PowerPoint
• Knowledge and understanding of computerized tracking systems and ability to gather and analyze statistical data, and generate reports.

Salary

$56,132 to $96,630