The Compliance Analyst position is responsible for assisting in meeting and exceeding regulatory and accreditation requirements with an emphasis on business and human improvement processes. This is a non-clinical position.
Essential Duties and Responsibilities:
• Tracks applicable licensing, laws and regulations in the jurisdictions where the organization conducts business and that might affect the organization's policies and procedures. This includes providing objective assessments of the company’s compliance to legislation governing the organization’s operations. Advise, counsel, and educate executive and management teams on the relative importance and financial impact of associated laws; recommend changes where necessary.
• Maintain current knowledge of accreditation, regulatory compliance, and licensure requirements such URAC, NCQA, Registered Nurse licensing, WFA, HIPAA and other applicable regulations.
• Manage, plan, organize, coordinate, and improve functions associated with accreditation and regulatory compliance to ensure that Carenet meets and exceeds a state of continuous standards compliance.
• Assess current approach to policy compliance and recommend/execute changes to assure continuous compliance with policy management requirements and effective monitoring of adherence to these policies.
• Perform and complete audits to meet client, regulatory, and accreditation requirements.
• Audit quality and compliance practices across the organization; isolate potential risks or liabilities and develop mitigation plans. Actively participates in audit activities in the organization.
• Oversees process for assuring that company policies and procedures are maintained and that appropriate processes to monitor and assure compliance are in place and effective.
• Assist in the implementation of quality and business process changes and maintain up to date business operations specific documentation.
• Create reports, charts and presentations using PowerPoint, Excel, Word and Access
• Provide training, coaching, and mentoring to staff as appropriate with input from HIPAA Privacy and Security Officers
• Perform other duties as assigned.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education/Experience: Bachelors degree (in business, or a related field) or 3+ years of equivalent combination of education and experience. .Experience and interest working in healthcare, HIPAA, URAC, NCQA and call centers is preferred.
Language Ability: Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
Math Ability: Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages.
Reasoning Ability: Ability to deal with and solve problems using solid judgment skills.
Technical skills: Word Processing, Spreadsheets, E-mail, database software, and Internet software. Experience with Project Management and office tools, including MS-Project & Visio.
• Ability to work in a fast-paced environment under tight deadlines. Must be flexible and able to effectively manage multiple priorities, and adapt to changing priorities.
• Excellent research, problem solving and analytical skills. Must be able to formulate and recommend solutions.
• Excellent documentation skills with emphasis on defining business and functional requirements.
• Ability to work independently, be self-motivated and take initiative.
• Ability to work with all levels of employees to define, develop and implement process improvements.
• Experience required with process improvements, technology integration, metrics development and business process design.
• Experience required with drafting policies and procedures
• Experience required in reviewing/auditing/analyzing compliance with regulatory requirements
• Experience required in developing and implementing necessary corrective action plans where there are identified gaps between processes and Privacy requirements
• Ability to work independently with minimal supervision
• Excellent organizational, written and verbal skills, with the ability to quickly analyze issues and craft practical, business-oriented solutions
• Exceptional analytical, problem solving, customer service, and presentation skills
• Ability to use judgment, tact and discretion and maintain a high level of confidentiality
• Proficiency in all Microsoft office programs including Word, Excel and PowerPoint
Certificates and Licenses: None
Supervisory Responsibilities: None
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is moderate. This job requires working in a business office with computers, printers, and light traffic.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, you must be able to sit for extended periods of time and communicate with callers through the use of a headset.
You must be able to lift up to 10 pounds, have close vision, color vision, depth perception, and ability to adjust your focus with good hand-eye coordination.
In 1988, Carenet Healthcare Services launched as a patient care advocacy and navigation operation within the Christus Santa Rosa Hospital...