Staffing Agency Houston - Contract & Direct Hire
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Compliance Analyst- Health Care

Compliance Analyst- Health Care

I.T. Staffing

Description

This is a long-term contract opportunity with our client, a hospital in Irving, TX.

As part of the Compliance team, this position contributes to ensuring compliance with applicable internal policies and procedures and external State and Federal agencies. This team member will assist in coordinating compliance activities, including but not limited to: complaints and appeals management, conducting internal risk assessments, ensuring the hospital meets contractual and regulatory requirements, preparing documents for regulatory filings, reviewing submissions for quality and accuracy, providing staff education and training on compliance-related requirements, and investigating/reporting suspected cases of non-compliance.

Responsibilities:

  • Reviews all contract reporting deliverables for compliance with contractual requirements and regulatory guidelines prior to submission.
  • Reviews all member and provider regulatory documents and marketing materials for compliance with contractual requirements prior to submission.
  • Ensures all regulatory information is accurately communicated and that all activities are submitted to the State and/or Federal entities in a timely manner.
  • Assists with the preparation of regulatory filings and works with other department leaders to ensure activities are well-coordinated and meet time-sensitive agency deadlines.
  • Analyzes statistical data and reports to identify and determine health care compliance issues.
  • Assists with the preparation of compliance audit data by compiling and analyzing internal and external information.
  • Coordinates and processes member and provider complaints and appeals.
  • Develops and maintains adequate information systems to assure timely and effective data collection, summarization, integration, and reporting which includes, but is not limited to, case creation and management and events/activity tracking.
  • Processes intake of complaints and appeals into the department’s tracking database.
  • Monitors incoming correspondence/faxes and route to the appropriate staff in a timely manner in accordance with established procedures and regulatory timeframes.
  • Assists in gathering comprehensive documentation, as needed, from internal and/or external sources relevant to issue(s) identified in cases.
  • Assists team in documenting/updating cases in tracking G&A database and/or systems and maintaining accurate complaint/grievance and appeal records.
  • Coordinates and ensures all relevant material is complete for external regulatory reviews (e.g. State Fair Hearing).
  • Maintains filing system to ensure that all case files are stored timely and accurately in the appropriate tracking database.
  • Tracks and trends complaints and appeals which includes production of internal and/or external reports.

Experience:
Required: Two years or more of health plan experience

Education:
Required: Associates Degree
Required: HCCA (preferred)

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