Compliance Analyst
New
J
JobgetherHealthcare compliance
Based in United StatesFull-TimeMiddle
SalaryAnnual salary of $85,000
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Job Details
- Experience
- At least 3 years of experience in Special Investigation Unit processes, healthcare compliance, fraud investigations, or a comparable role.
- Required Skills
- Project ManagementData AnalysisMicrosoft ExcelHIPAA
Requirements
- Bachelor’s degree required.
- At least 3 years of experience in Special Investigation Unit processes, healthcare compliance, fraud investigations, or a comparable role.
- Previous healthcare industry experience required; DMEPOS experience is strongly preferred.
- Strong knowledge of fraud, waste, and abuse, healthcare credentialing, medical billing, HIPAA, and related healthcare legislation and regulations.
- Working knowledge of medical billing processes and healthcare compliance practices.
- Experience working with data and advanced proficiency in Microsoft Excel; Tableau experience is a plus.
- Ability to interpret complex information and communicate it clearly to technical and non-technical audiences.
- Strong written and verbal communication skills and ability to work with clients, executives, and cross-functional stakeholders.
- Strong organizational and project management skills, including managing multiple priorities and deadlines.
- Integrity, ethics, discretion, and professional judgment when handling sensitive and confidential information.
Responsibilities
- Conduct audits of healthcare providers and vendors to support fraud, waste, and abuse monitoring and compliance programs.
- Lead or support FWA investigations, research providers and regulatory alerts, and investigate internal and external compliance concerns.
- Administer and improve the corporate compliance program, including assigning training and maintaining auditable records.
- Collaborate with credentialing, quality assurance, network management, security, and other teams to address concerns and implement corrective actions.
- Partner with health plan customers on business audits by developing, documenting, tracking, and responding to audit requests.
- Monitor licensing requirements and state regulatory filings.
- Conduct security risk assessments, present findings to the compliance committee, and work with security teams to resolve issues.
- Monitor regulatory and industry developments affecting healthcare and DMEPOS operations and recommend updates to processes, policies, and controls.
- Manage assigned audits and projects, multiple priorities, and deadlines.
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