The Senior Compliance Analyst supports 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.
The selected candidate must reside in North Carolina and will be required to come into to the home office (Morrisville, NC), at least (1) day a week to work, as approved by their supervisor.
Responsibilities & Duties
Maintain Requirements Inventory
Maintain an inventory of all internal and external requirements and monitor for changes in current laws and regulations
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
Train and Consult with Employees
Aid staff 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
Participate in the development of and facilitate compliance and ethics training, education or communication to internal departments and network providers
Maintain reporting related to adherence to training requirements and effectiveness of training efforts
Conduct Audits and Investigations and Monitor Implementation of Resolutions
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
Conduct privacy audits, communicate findings to Privacy/Security Officer and management to ensure any identified issues are resolved
Develop and prepare reports of factual observations, findings and recommendations designed to strengthen internal controls or improve operating procedures
Conduct compliance investigations, documents findings, and presents results to the Chief Compliance Officer. 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 Chief Compliance Officer or Privacy/Security Officer
Maintain records of assigned inquiries and track research and disposition of compliance issues raised by senior management, employees, business partners and external auditors
Minimum Requirements
Education & Experience
Required:
Bachelor’s degree from an accredited college or university in healthcare, business administration, public policy, accounting, or related field plus a minimum of seven (7) years’ experience in health care compliance, auditing, regulatory or law.
Preferred:
• At least one (1) year previous healthcare compliance related experience preferred.
• Direct experience in compliance auditing and compliance investigations.
• Certified in Healthcare Compliance (CHC), Healthcare Privacy Compliance (CHPC), Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified Internal Auditor (CIA), or other similar professional certification.
Knowledge, Skills, & Abilities
Possess knowledge of applicable state and federal laws, HIPAA Privacy and Security regulations, administrative rules, state policies, and other regulations pertaining to Medicaid managed care.
A general understanding of all major organization 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.
Behaves in an honest, fair, and ethical manner. Shows consistency in words and actions. Models high standards of ethics
Demonstrated knowledge of investigative techniques and methods
Knowledge and understanding of computerized tracking systems and ability to gather and analyze statistical data and generate reports with high attention to detail
Salary Range
$75,600.00 to $96,390.00/Annually
Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.
An excellent fringe benefit package accompanies the salary, which includes:
Medical, Dental, Vision, Life, Long Term Disability
Generous retirement savings plan
Flexible work schedules including hybrid/remote options
Paid time off including vacation, sick leave, holiday, management leave
