Compliance Analyst I

KHS reasonably expects to pay starting compensation for the position of Compliance Analyst I in the range of $35.50 - 47.48 hourly. Our Mission.. Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.    Definition   Under the general direction of the Compliance Manager, this position is responsible for coordination, assessment, research, analysis, maintenance and auditing of key compliance matters. Under supervision, this position assists in the coordination, tracking, and filing of regular and ad-hoc reporting to State, Federal and other regulatory agencies.   Distinguishing Characteristics   The Compliance Analyst will work closely with the Compliance Manager  in order to develop business process improvement recommendations based on findings from both internal and external audits.  Strong verbal and written communication skills are required for communicating at all levels within the company. Critical thinking and the ability to deal with both qualitative and quantitative information to develop professional materials for internal customers is essential. This position may require interaction with KHS Stakeholders from time to time.   Essential Functions   Supports the development and renewal of state contracts and contract amendments, including coordination, verification, writing revisions of the EOC and submitting to the state.  Conducts or assists in conducting risk assessments of KHS’s business practices and determining areas of exposure; recommends mitigation plans as needed.  Conducts research and analysis on contractual and regulatory requirements with respect to KHS and delegated vendors.  Maintains the compliance audit program, including schedules, standards, processes, reports and tools in close collaboration with the Compliance management.  Conducts and coordinates routine and ad-hoc internal and external audits and identifies gaps that require corrective action plans.  Coordinates or manages implementation of internal and external corrective action plans, monitoring progress and completion, coordinating interviews and document gathering; escalates as required.  Provides guidance to internal and external stakeholders to ensure understanding and compliance with regulatory, contractual and accrediting requirements, and organization policies and procedures.  Leads the compilation and tracking of deliverables; reviews deliverables for accuracy and facilitates corrections; obtains appropriate approvals and submits deliverables according to timelines.  Analyzes and investigates suspected FWA and Privacy incidents for root cause, trends and tracks data to translate findings and develop processes for improvement or investigation.  Evaluates financial impact of identified compliance issues, and reports findings.  Develops and maintains routine and ad hoc Compliance Reporting, including but not limited to detailed and summary level reporting via written interpretation of analytical results to present to internal and external stakeholders.  Enters and maintains data, information, documents and files according to standards, including but not limited to compliance software.  Works on process improvement projects related to audit findings or business controls issues. Performs monitoring of subcontractor to ensure compliance contract requirements. Ability to organize meetings and capture meeting action items (Compliance Committee, Fraud, Waste and Abuse Committee, and Delegated Oversight Committee) meetings in a software solution. In-depth knowledge of federal and state regulations and standards, including False Claims Act, Medi-Cal and DMHC/DHCS standards as they relate to compliance in health care.  In-depth knowledge of managed care health plan functions and interactions as they relate to compliance.  In-depth knowledge of contracting regulations and best practices.  Basic knowledge of ICD-10 and CPT coding and medical terminology, and industry standard payment practices.  In depth knowledge of audit, control and monitoring processes, and the ability to effectively implement and maintain them.  Strong analytical skills, including the ability to perform routine analysis, using identified data, information and/or issues, and provide recommendations.  Produces work that is accurate and complete.  Produces the appropriate amount of work.  Actively learns through experimentation when tackling new problems, using both successes and failures to learn.  Rebounds from setbacks and adversity when facing difficult situations.  Knows the most effective and efficient process to get things done, with a focus on continuous improvement.  In-depth knowledge of basic data analysis tools and techniques, with ability to analyze and interpret data.  Strong problem-solving skills, with the ability to identify and resolve problems of moderate complexity.  Strong research skills with the ability to identify and review complex materials to develop and evaluate options and propose solutions.  Strong organizational and project management skills, with the ability to prioritize and complete a variety of tasks and prioritize work of others.  Interpersonal skills - interacts effectively with individuals both inside and outside of KHS; relates openly and comfortably with diverse groups of people.  Strong oral and written communication skills with the ability to communicate professionally, effectively and persuasively to diverse individuals and groups inside and outside of KHS; the ability to effectively explain complex information and document according to standards.  Strong presentation skills, including the ability to tailor presentations to a specific audience, and address and interact with large groups.  Time management: Uses time effectively and efficiently; values time; concentrates his/her efforts on the more important priorities; can attend to a broader range of activities; meets deadlines.  Strong leadership skills, with the ability to influence without authority, establish direction, build alliances and motivate others.  Commitment to and ability to facilitate the adoption of KHS’s strategy, vision, mission and values.  Strong mathematics skills, including the ability to calculate ratios, perform simple algebra and statistical formulas.  Intermediate skills in Word, Excel, Power Point, Visio and Project.  Ability to speak and be understood in English.  Ability to handle confidential information with appropriate discretion.  Knowledge of general project planning, coordination, and administrative practices. Coordinates, prepares and monitors special projects and reports as required. Evaluates Business Associates HIPAA Privacy and Security compliance efforts Builds and distributes report to company stakeholders on HIPAA Privacy and Security compliance current state and suggested efforts. Assesses existing internal systems and recommends technical improvements (e.g., performance upgrades). Recommends, establishes business case, and assists management and others in building acceptance of new proposed APLs and procedures. Participate in regulatory- Department meetings and webinars and lead action needed in response to these sessions. Complete timely review and disposition of referrals and inquiries in coordination with internal stakeholders. Other projects and duties as assigned.   Employment Standard:   Education:   Associates degree in healthcare, business, or related field from an accredited institution or equivalent AND three (3) years' experience within the financial, claims, legal or regulatory support required, preferably in the health care industry.    OR   Experience:   Five (5) years’ experience within the financial, claims, legal or regulatory support required, preferably in the health care industry with (1) year experience in health insurance and HMO compliance highly desirable.   Knowledge of:    Medi-Cal; managed care. Center for Medicare and Medicaid Services (CMS) Claims, Utilization Management, and other health plan departmental processes and procedures; project management process; reporting tools and analysis, report generation, implementation of business controls.

Salary : $36 - $47