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Compliance Analyst (Medical Management)
Exempt or Non-ExemptExempt
Conduct activities under minimal direction that support government regulations, accreditation standards and specific HMSA line of business requirements; lead/participate on project teams to share expertise and facilitate completion of deliverables.
- Bachelor's Degree and two years of related work experience; or equivalent combination of education and related work experience.
- Proficient in the use of all Microsoft Office applications and Internet searches.
- Strong verbal and written communication skills;
- Excellent analytical, organizational and time-management skills.
- Recognized leadership abilities.
Duties and Responsibilities
- Monitor and analyze regulatory/accreditation/business requirements to invoke recommendations for program and/or policy changes as appropriate for various lines of business.
- Lead/coordinate activities, which include internal audits, quality assurance control, quality improvement, provider satisfaction and department policies and procedures, to meet and/or maintain regulatory/accreditation/line of business requirements.
- Serve as a resource to internal and external staff regarding issues relating to administrative policies and procedures, medical policies, and researching and resolving problems.
- Edit all documentation generated by unit e.g., QIAs, reports, executive summaries, presentation materials, workplans, evaluations, annual plans, policies and procedures, minutes, agendas, provide feedback, and develop/generate monitoring reports/tools.
- Coordinate/schedule training opportunities and develop/present related reports and various documentation.
- Coordinate, support and document various department activities to ensure deliverables are completed by due date.
- Perform other duties (e.g., attend meetings) as assigned.