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Medicare Compliance Analyst II or III

4 months ago

Portland, United States Cambia Health Solutions, Inc Full time

Compliance Analyst II or III

Work Remotely from Oregon, Washington, Idaho or Utah

Primary Job Purpose

As a member of the Compliance team, the Compliance Analyst is responsible to deliver an effective compliance program. They design, implement, deliver, measure and refine activities and controls to prevent, detect and correct violations of state, federal and other laws. Duties may include, but are not limited to, risk assessment, training, monitoring, auditing, external audit coordination, investigation, root cause analysis, regulatory implementation, control assessment, reporting, and corrective actions. Grade level at hire and upon promotion will be based on such factors as experience, performance, complexity and scope of work assigned, knowledge, and influence skills. This role may be specific to a product line or area, or may have a broader scope. Special projects may be assigned as needed.

We are seeking an individual with Medicare compliance experience to assist in prevention, detection, and remediation activities. Experience in risk adjustment compliance (Medicare and ACA) as well as a coding certification is preferred.

General Functions and Outcomes

  • Overall responsibilities include specific and/or portions of the following functions that relate to an effective compliance program utilizing as a basis the seven elements of compliance.

  • Duties include aspects of the preparation, planning, coordination, project management, submission, administration, monitoring and auditing of the Cambia compliance program which serves to oversee activities related to requirements, laws and regulations to prevent, detect and remediate compliance issues of the company.

  • Responsibility for producing and maintaining policies and desk manuals for position.

  • Works as a team with other staff members assigned in either a supporting or leading role.

  • Participating in the annual risk assessment process.

  • Ensuring materials, reports, and other documents are written in an understandable and concise style.

  • Project management and implementation.

  • Participating, supporting and serving in regular meetings, including divisional and cross-divisional committees as needed.

  • Core Competencies: risk assessments, training, policies and procedures, training, monitoring, auditing, root cause analysis, and corrective actions.

  • Additional Competencies: external audit coordination, implementations, control assessments, delegation oversight, data validation, marketing material oversight, DDE/FDR oversight.

Minimum Requirements (Compliance Analyst II and III)

  • Proven ability to deliver effective Core Compliance activities, including, monitoring, auditing, root cause analyses, and corrective actions.

  • Skilled in project management and delivery including proven ability to initiate and manage multiple projects and priorities.

  • Excellent written and oral communication and presentation skills.

  • Excellent research and analytics skills, with proven ability to distill actionable, practical advice from diverse sources and opinions. Legal research skills preferred.

  • Proven ability to influence effectively at all levels of the organization.

  • Excellent independent judgment and decision-making skills.

  • PC literate with office computer software - Word, Excel, PowerPoint, Outlook, Visio, etc.

  • Discretion and confidentiality.

  • Agile, with high learning velocity.

  • Demonstrated fluency in organizational agility: knowledgeable how about organizations work and how to get things done through formal and informal channels.

  • Practical familiarity with legal requirements relating to assigned compliance program, or for new hires, practical familiarity with analogous legal requirements.

  • Demonstrated mastery of at least four Compliance functions , to include the core competencies: risk assessments, training, policies and procedures, monitoring, auditing, external audit coordination, control assessments, reporting, corrective actions, implementation oversight, and ability to perform those compliance functions effectively within that compliance program; or if assigned to a specialized function (e.g. FDR/ DDE Compliance, Marketing Materials Review, Data Validations), mastery of all competencies related to that specialized function.

  • Demonstrated ability to handle successfully the most complex, most difficult matters end-to-end.

  • Demonstrated ability to drive success with the most challenging and/or most elevated partners.

Additional Minimum Requirements (Compliance Analyst III)

  • Demonstrated mastery of legal requirements relating to assigned compliance program; or for new hires, demonstrated mastery of analogous legal requirements.

  • Demonstrated mastery of at least 6 core compliance functions, including the core competencies and ability to deftly perform all compliance functions relating to assigned compliance program as needed.

  • Demonstrated excellence in building effective relationships at all levels of the organization; influencing decision-making; effectively framing issues and dialogues; and driving successful outcomes.

  • Demonstrated, end-to-end operational knowledge relating to assigned compliance program.

  • Demonstrated peer mentoring and departmental leadership.

Normally to be proficient in the competencies listed above

Compliance Specialist II would have a Bachelor's degree or equivalent experience; 5 years of compliance experience or equivalent related experience, with experience in a health care or Medicare-regulated environment preferred.

Compliance Specialist III would have at least a Bachelor's degree or equivalent experience; 8 years of compliance experience or equivalent related experience, with experience in a health care or Medicare-regulated environment or ACA-regulated environment preferred.

Work Environment

  • Travel rarely required, locally or out of state.
  • May be required to work outside normal hours.