HEALTHCARE COMPLIANCE SPECIALIST
3 weeks ago
Key Responsibilities:
• Drive critical data analysis through regular oversight and monitoring activities using expense data, customer master, and other fee-for-service data with an eye toward automation.
• Assist HCCOs in providing guidance and oversight on business programs, initiatives, and processes based upon insights and trends identified from monitoring activities.
• Complete special projects as identified, working across HCC and other business functions.
• Prepare and present presentations to HCC Officers highlighting monitoring trends and areas of risk.
• Contribute to Program Management oversight & monitoring efforts by serving as a liaison between HCC Officers, Compliance & Technology Integration (CTI), and Global Assessment and Consulting Services (GACS), reviewing monitoring reports, analyzing for potential issues and trends, conducting, and documenting follow-ups, recommending enhancements, and capturing insights and trends in collaboration with the HCC Officers.
• Identify and/or implement business efficiencies, technology solutions, process improvements and enhanced reporting capabilities to assist in the implementation of a sustainable HCC program.
• Assist in coordinating Risk Assessment process for the region and identifying and driving process improvements across the team. Develop and implement metrics, templates, and/or scorecards to support annual risk assessment and quarterly risk reviews.
• Provide transactional reviews of transfers of value to health care professionals and government officials, perform reviews of material, and engage with business partners to provide guidance on HCC-sensitive topics in alignment with HCC policies/procedures.
• Partner with HCC leadership and HCCOs to create and deliver targeted HCC communications to the HCC community or business partners.
• Assist in developing and/or revising training to support HCC program elements. Collaborate with third-party vendor to communicate training needs.
• Collaborate with HCC Officers to facilitate revisions to HCC policy manual and supporting policy documents as needed
Qualifications
Education:
• A minimum of a Bachelors’ Degree or equivalent degree
Experience and Skills:
Required:
• Minimum of 1 year business experience
• Excellent English verbal and written communication skills, including formal presentation skills.
• Ability to collaborate in a cross-functional team environment.
• High quality standard with a strong work ethic and professionalism to co-workers and customers.
• Experience identifying and/or implementing process improvement.
• Skill analyzing large data sets.
Preferred:
• At least 1 year in HCC or a compliance related area: monitoring, testing, auditing, finance, compliance, regulatory, law, or a related field
• Ability to work in a complex business environment required
• Demonstrated experience in prioritizing needs and implementing system or process enhancements preferred.
• The ability to break apart large/complex issues into manageable components using analytical skills is necessary.
• Experience working with database and reporting tools preferred.
• Prior experience and/ or training in analytics is preferred.
• Knowledge and experience in the application of web-based reporting tools, website maintenance and/or knowledge of SharePoint is a preferred. Experience in Healthcare Compliance transparency reporting or financial data analysis is preferred
• Experience with data modeling tools
• Self-starter with ability to work independently is preferred
-
Healthcare Compliance Specialist
1 month ago
New York, United States Healthcare Enterprise Full timeJob DescriptionJob DescriptionThe Compliance Specialist oversees the Compliance Program for the Home Care agency, ensuring adherence to local, state laws, and regulations outlined by the New York State Department of Health, Office of Medicaid Inspector General, and company policies. This role includes the continual implementation of the Code of Conduct and...
-
Healthcare Compliance Analyst
4 weeks ago
New Brunswick, United States ZP Group Full timePiper Companies is looking for a Compliance Analyst HCC - Enterprise R&D to provide Healthcare Compliance support working for a Pharmaceutical company in New Brunswick, NJ. Responsibilities for the Compliance Analyst HCC - Enterprise R&D include: * Review simple transactions created to support business activities and open payments requirements in support...
-
Healthcare Compliance Analyst
1 day ago
New Brunswick, United States Piper Companies Full timePiper Companiesis looking for a Compliance Analyst HCC - Enterprise R&D to provide Healthcare Compliance support working for a Pharmaceutical company in New Brunswick, NJ . Responsibilities for the Compliance Analyst HCC - Enterprise R&D include: Review simple transactions created to support business activities and open payments requirements in support of...
-
Healthcare Compliance Analyst
4 weeks ago
New Brunswick, United States Piper Companies Full timePiper Companies is looking for a Compliance Analyst HCC - Enterprise R&D to provide Healthcare Compliance support working for a Pharmaceutical company in New Brunswick, NJ .Responsibilities for the Compliance Analyst HCC - Enterprise R&D include:Review simple transactions created to support business activities and open payments requirements in support of...
-
Recruiting and Compliance Specialist
4 weeks ago
New Brunswick, United States AM Home Delivery Full timeJob DescriptionJob DescriptionWe are seeking a highly motivated individual to join our team as a Logistics Recruiter and Compliance Specialist. In this role, you will be responsible for assisting in the recruiting process and onboarding of employees while working closely with the compliance team and be familiar with general DOT, FMCSA, and CSA rules and...
-
Lab Software Compliance Specialist
4 days ago
New Brunswick, New Jersey, United States Thermo Fisher Scientific Full timeJob DescriptionThermo Fisher's clinical research business is a leading global contract research organization and world leader in serving science. We are passionate, deliberate, and driven by our mission – to enable our customers to make the world healthier, safer, and cleaner.Within our Analytical Services team, we have a functional service provider...
-
Compliance Specialist
4 days ago
New York, United States WEST SIDE FEDERATION FOR SENIOR AND SUPPORTIVE HOUSING, INC. Full timeJob DescriptionJob DescriptionJob DescriptionCompliance SpecialistSummary DescriptionReporting to the Assistant Director of Compliance, the chief responsibility for the Compliance Specialist is to assist in achieving quality compliance with the requirements of the WSFSSH’s external funders and regulators, thereby safeguarding WSFSSH’s assets and income...
-
Sr. QC Compliance Specialist
4 days ago
New Brunswick, United States Sun Pharmaceutical Industries Full timeCOME WORK FOR US - INVESTING IN YOU AS A SUN PHARMA EMPLOYEE! * Medical, Dental, Vision Benefits * Health Savings Account (HSA), Flexible Spending Account (FSA) * Prescription Drug Coverage * Telehealth and Behavior Health Services * Income Protection - Short Term and Long Term Disability Benefits * Retirement Benefits - 401k Company Match on Day One (100%...
-
Legal Compliance Specialist
4 weeks ago
New York, New York, United States Archstone Builders LLC Full timeLegal Compliance Specialist, New York, NY Archstone Builders LLC, one of the leading construction mgmt firms, is seeking candidates for a Legal Compliance Specialist position to consult with legal counsel & report to mgmt on compliance matters; monitor, research & analyze local, city, state & fed laws & regs for compliance & of changes that require...
-
Agriculture Compliance Specialist 1, 2
5 days ago
Brunswick, United States GeorgiaGov Full timeWe at the Georgia Department of Agriculture (GDA) take our responsibilities to you very seriously and are committed to protecting and promoting Georgia's agriculture through superior service and leadership. ·The vision of the GDA is to continue to be a globally recognized leader in agricultural excellence through a commitment to safety, quality, growth,...
-
Healthcare Compliance Auditor
1 week ago
New York, United States MJHS Full timeOur Corporate team may not provide direct care, but we still touch people's lives in a very real and substantial way. The services we provide contribute greatly to the overall patient and member experience, supporting our reputation for excellence. Under the direction of the MJHS Compliance Officer and working closely with members of the MJHS Compliance...
-
Medicare Regulatory Compliance Specialist
2 weeks ago
New York, United States NYC Health Hospitals Full timeMetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned...
-
Telecommute Healthcare Reimbursement Specialist
2 weeks ago
New Providence, NJ, United States PRISM Vision Group Full timeThe Revenue Cycle Specialist is responsible for billing and collecting payments. This position ensures that all accounts are billed appropriately and meets all regulatory and compliance requirements. Respond to inquiries from insurance carriers, via telephone, email or fax and demonstrate a high level of customer service. Pursue reimbursement from...
-
New Providence, NJ, United States PRISM Vision Group Full timeThe Revenue Cycle Specialist is responsible for billing and collecting payments. This position ensures that all accounts are billed appropriately and meets all regulatory and compliance requirements. Respond to inquiries from insurance carriers, via telephone, email or fax and demonstrate a high level of customer service. Pursue reimbursement from...
-
Healthcare Compliance Auditor
6 days ago
New York, United States Metropolitan Jewish Health System Full timeOverview: Our Corporate team may not provide direct care, but we still touch people's lives in a very real and substantial way. The services we provide contribute greatly to the overall patient and member experience, supporting our reputation for excellence. Why work for MJHS?: When you work with us you will receive comprehensive and affordable health and...
-
Compliance Specialist
2 weeks ago
New York, United States Global Commodities Trading Company Full timeGlobal Metals Trading Firm located in Midtown Manhattan is seeking a Compliance Specialist to add to their growing team. They will train an individual who has 1-2 years work experience and is a self starter and very detailed for research and has excellent writing skills. This is not a KYC or AML Banking Compliance position. Summary: This position reports...
-
Medicare Regulatory Compliance Specialist
1 week ago
New York, United States MetroPlusHealth Full timeJob DescriptionJob DescriptionEmpower. Unite. Care.MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.About NYC Health +...
-
Compliance Specialist
1 week ago
New York, United States Global Commodities Trading Company Full timeGlobal Metals Trading Firm located in Midtown Manhattan is seeking a Compliance Specialist to add to their growing team. They will train an individual who has 1-2 years work experience and is a self starter and very detailed for research and has excellent writing skills. This is not a KYC or AML Banking Compliance position. Skills, Experience,...
-
Compliance Specialist
2 weeks ago
New York, United States Global Commodities Trading Company Full timeGlobal Metals Trading Firm located in Midtown Manhattan is seeking a Compliance Specialist to add to their growing team. They will train an individual who has 1-2 years work experience and is a self starter and very detailed for research and has excellent writing skills. This is not a KYC or AML Banking Compliance position. Summary:This position reports...
-
Compliance Specialist
2 weeks ago
New York, United States Global Commodities Trading Company Full timeGlobal Metals Trading Firm located in Midtown Manhattan is seeking a Compliance Specialist to add to their growing team. They will train an individual who has 1-2 years work experience and is a self starter and very detailed for research and has excellent writing skills. This is not a KYC or AML Banking Compliance position. Summary:This position reports...