Centers Plan for Healthy Living

  • Compliance Audit Analyst

    Job Locations US-NY-Jamaica
    Posted Date 4 months ago(4 months ago)
    ID
    2018-1300
    # of Openings
    1
    Category
    Compliance
  • Overview

    New CPHL Logo

     

     

     

    JOB SUMMARY:

     

    The Compliance Audit Analyst works with the Compliance Audit Team and Internal Business Partners to ensure the health plan’s compliance.

    The Compliance Audit Analyst demonstrates knowledge of Medicare (Parts C and D); Medicaid Managed Long Term Care, and Fully Integrated Medicaid Advantage (FIDA) plan requirements and compliance monitoring activities to effectively perform duties that support the company’s compliance program. The Compliance Audit Analyst will initiate and perform all stages of Corrective Action Plan management and monitoring resulting from internal and external audits, or self-identified deficiencies.   The Analyst must possess knowledge of operational areas such as appeals and grievances, enrollment and disenrollment, customer service, provider relations and contracting, and other functions relating to compliance with governmental regulations and health plan policies.   

     

     

    Responsibilities

    PRIMARY RESPONSIBILITIES:  

    • Corrective Action Plan process from initiation through completion (i.e. issue identification, root cause determination, impact analysis, corrective action evaluation and monitoring, etc.)
    • Assist with compliance audits and monitoring of various health plan operations
    • Prepare audit and investigation reports of findings and observations that identify, in detail, areas of non-compliance and risk areas for non-compliance
    • Review policies and marketing materials for compliance with CMS and NYSDOH regulations
    • Submit marketing materials for review and approval by CMS and NYSDOH
    • Document all compliance activities in accordance with department polices and/or workflows
    • Assist the Compliance Audit Team as needed

    Qualifications

    Education and Experience:

     

    Education

    Required:   An Associate’s Degree or higher

    Preferred:    A Bachelor’s Degree or higher

    Type of Experience                                          

    Required:   

    • 5 or more years of experience in compliance-related matters in the Medicare/Medicaid Managed Care industry, or equivalent combination of education and work experience.
    • Experience in developing, implementing and monitoring Corrective Action Plans (CAPs)

    Preferred:   Experience in a claims environment and medical coding helpful.

    Specific Technical Skills

    Preferred:    Not Applicable

     

    Certifications/Licensure:

    Required:   Not Applicable

    Preferred:   Not Applicable

                

    Knowledge and Skills:

    Required:   

    • Knowledge of Medicare Advantage Part C and Part D, and Medicaid Managed Long Term Care and Fully Integrated Medicaid Advantage (FIDA) plan regulations required.
    • Ability to work closely with business units to determine the root cause and develop CAPs
    • Efficient in documenting, tracking and following up on CAPs through completion
    • Knowledge or the Medicare Marketing Material review process
    • Proficient with MS-Office Excel, Visio, PowerPoint, etc.
    • User knowledge of health care related computer systems/applications

     

    Preferred: Not Applicable

     

    SCOPE INFORMATION

    # Direct Reports: None

    Physical Requirements:

    The physical requirements 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.

     

    ·          

     

    The above statements are intended to describe the general nature and level of work performed by individuals assigned to the job classification.  They should not be construed as an exhaustive list of all responsibilities, duties and skills required.

     

    Options

    Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
    Share on your newsfeed