Senior Compliance Analyst

3 weeks ago

Chula Vista, United States Community Health Group Full time

POSITION SUMMARY

Under the supervision of the Compliance and Ethics Officer ("CO") and other Compliance Department staff as applicable, help ensure Community Health Group ("CHG") complies with applicable federal, State, and local laws, regulations, and contract requirements through the creation and maintenance of an effective compliance program.

COMPLIANCE WITH REQUIREMENTS

Comply with all applicable legal and compliance requirements, including but not limited to federal and State laws and regulations; privacy, confidentiality, and information security mandates; and CHG policies and procedures.

POSITION DUTIES

* Assist in the management of day-to-day operations of the Compliance Department.


* Contribute to the achievement of established Department goals and objectives and adhere to Department policies, procedures, and standards.


* Organize and maintain inventory of Compliance Department policies and procedures.


* Maintain a strong working knowledge of all applicable legal, regulatory, contractual, and accreditation requirements. Update job knowledge by participating in educational opportunities and reading professional publications.


* Perform special projects as requested.


* Discharge other duties as may be required in the course of business or as may be assigned by the CO.



First Tier Downstream and Related Entities ("FDR") Oversight Program

* Under the direction of the CO, timely and comprehensively coordinate and perform all FDR audits, investigations, CAPs, education and training, and Program development and risk management.


* Work with all CHG stakeholders to ensure the FDR Oversight Program requirements are accomplished in a timely, comprehensive, and effective manner, in accordance with CHG's FDR policies and procedures, and in compliance with applicable State and federal regulations, Centers for Medicare and Medicaid Services ("CMS") contractual requirements, including CFR Title 45 and other applicable legal and regulatory requirements.


* Track and provide FDR Oversight Program reports on a regular basis, and as directed or requested.



Fraud Waste and Abuse Prevention and Detection Program ("FWA Program")

* Under the direction of the CO, timely and comprehensively coordinate, monitor, and perform duties related to CHG's FWA Program, including investigations, CAPs, education and training, and FWA Program development and risk management. Work with Compliance Department stakeholders as needed to accomplish these tasks.


* Work with all CHG stakeholders to ensure the FWA Program requirements are accomplished in a timely, comprehensive, and effective manner, in accordance with CHG's FWA policies and procedures, and in compliance with applicable State and federal regulatory, legal, and contractual requirements.


* Track and provide FWA Program reports on a regular basis, and as directed or requested.



Privacy Compliance Program

* Under the direction of the CO, timely and comprehensively coordinate and assist in the implementation and maintenance of the Compliance Program.


* Assist in the investigation of potential privacy incidents.



Regulatory Affairs

* Support the Regulatory Affairs Manager in timely and comprehensively coordinating and performing all CHG regulatory reporting, including with the Department of Managed Health Care ("DMHC") and the Department of Health Care Services ("DHCS").


* Assist with and track responses to regulatory inquiries, investigations, data, and other requests.


* Under the direction of the CO assist with the coordination of the CMS, DMHC and DHCS audits.


* Serve as one of CHG's Compliance Department liaisons with regulatory agencies, including for responses to State inquiries, audits, and report requests. Assist in the drafting and review of responses to regulatory agencies.



ADMINISTRATION AND MANAGEMENT

* Not applicable.



Qualifications

Education

* Bachelor's Degree in compliance, health policy, health administration, legal or regulatory affairs, or other related discipline strongly preferred. Managed health care management experience may be considered in lieu of academic training.


* Certification in Healthcare Compliance ("CHC") from the Health Care Compliance Association is preferred.



Experience/Skills

* Minimum four or more years' experience in auditing, compliance, legislative affairs, regulatory affairs, or public policy analysis preferred.


* Four or more years in a managed care setting strongly preferred.


* Customer service skills with the ability to interact professionally and effectively with all stakeholders.


* Excellent written and verbal communication skills and detail oriented.


* Understanding of NCQA, State/Federal legislative and regulatory processes, health plan operations, and the relationships between departments and functional areas.


* Hands on compliance implementation experience with health care industry statutory, regulatory, and/or accreditation requirements, preferably with CMS, DMHC, and/or DHCS.


* Demonstrated ability to utilize and apply internal compliance auditing principles, practices, and techniques.


* Strong abilities to organize and prioritize work effectively; manage projects; and apply established policies procedures and guidelines for problem-solving and decision making.


* Ability to maintain confidentiality and comply with applicable privacy and confidentiality requirements.


* Intermediate to advanced level proficiency with MS Office applications (Word, Excel, PowerPoint, Access), expertise with graphics and presentation software.


* Strong attention to detail.



Physical Requirements

* Prolonged periods of sitting.


* Some travel, including driving within the County of San Diego.



Must have current authorization to work in the USA

Community Health Group is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment based on any protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, and trainings. Community Health Group makes hiring decisions based solely on qualifications, merit, and business needs at the time. For more information, see Personnel Policy 3101 Equal Employment Opportunity/Affirmative Action

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.

  • Compliance Analyst

    1 week ago

    Chula Vista, United States Community Health Group Full time

    POSITION SUMMARY Conducts internal audits of all departments and oversees internal monitoring activities conducted by others to determine that core department activities are in compliance with established management control systems, provides analysis and reports of audits to Compliance Manager and works with Compliance department to implement and monitor...

  • Senior Analyst Royalties

    4 days ago

    Chula Vista, California, United States Enovis Full time

    At Enovis we sweat the little things. We embrace collaboration with our partners and patients, and we glory in the grind of scientific excellence - with the goal of transforming medical technology as we know it. Because that's how we change the lives of patients for the better. And that's how we create better together. Job Title: Senior Analyst Royalties &...

  • Compliance Auditor

    3 weeks ago

    Chula Vista, United States Community Health Group Full time

    POSITION SUMMARY The Compliance Auditor will support the director in compliance with audits of various functional areas including evaluation of effectiveness of risk management practices or internal controls. In addition, the auditor will analyze audit results, prepare presentations of findings, and develop recommendations meant to reduce risk and increase...

  • Oracle HRIS Analyst

    2 weeks ago

    Chula Vista, United States Slate Professional Resources Full time

    Job Description: Oracle HRIS Analyst Position Overview: We are seeking a skilled and experienced Oracle HRIS Analyst to join our team and play a crucial role in the successful implementation, configuration, and integration of the Oracle Human Resources Information System (HRIS). As an Oracle HRIS Analyst, you will work closely with cross-functional...

  • EDI Programmer/Analyst

    5 days ago

    Chula Vista, United States Community Health Group Full time

    POSITION SUMMARY Meets the needs of system users by meeting independently or as an Information Systems (IS) team member with the appropriate people to determine business needs; gathering information in order to define and develop reports and applications to meet those business needs including all those related to EDI; developing and maintaining Community...

  • EDI Programmer/Analyst

    3 days ago

    Chula Vista, United States Community Health Group Full time

    Job DescriptionJob DescriptionPOSITION SUMMARYMeets the needs of system users by meeting independently or as an Information Systems (IS) team member with the appropriate people to determine business needs; gathering information in order to define and develop reports and applications to meet those business needs including all those related to EDI; developing...

  • EDI Programmer/Analyst

    5 days ago

    Chula Vista, United States Kickr Design Full time

    Position SummaryMeets the needs of system users by meeting independently or as an Information Systems (IS) team member with the appropriate people to determine business needs; gathering information in order to define and develop reports and applications to meet those business needs including all those related to EDI; developing and maintaining Community...

  • EDI Programmer/Analyst

    5 days ago

    Chula Vista, United States Community Health Group Full time

    POSITION SUMMARY Meets the needs of system users by meeting independently or as an Information Systems (IS) team member with the appropriate people to determine business needs; gathering information in order to define and develop reports and applications to meet those business needs including all those related to EDI; developing and maintaining Community...

  • Maintenance Director

    2 days ago

    Chula Vista, United States Pacifica Senior Living Full time

    _**Pacifica Senior Living is looking for a Maintenance Director to join our team!**_ Pacifica Senior Living is a dynamic growing senior living company that provides elegant senior living throughout the United States. We are always seeking highly motivated, focused, and determined people to join our team! Our Senior Living options include: Independent...

  • Business Systems Analyst

    1 month ago

    Chula Vista, United States Community Health Group Full time

    Job DescriptionJob DescriptionPOSITION SUMMARYMeets the needs of system users by working with the appropriate staff to determine business requirements; gathering information to define and program reports and applications to meet those business needs; providing technical assistance to Information Systems (IS) staff, developing written documentation such as...

  • Business Systems Analyst

    4 weeks ago

    Chula Vista, United States Community Health Group Full time

    Job DescriptionJob DescriptionPOSITION SUMMARYMeets the needs of system users by working with the appropriate staff to determine business requirements; gathering information to define and program reports and applications to meet those business needs; providing technical assistance to Information Systems (IS) staff, developing written documentation such as...

  • Senior Analyst Royalties

    4 days ago

    Vista, United States Enovis Full time

    At Enovis we sweat the little things. We embrace collaboration with our partners and patients, and we glory in the grind of scientific excellence - with the goal of transforming medical technology as we know it. Because that's how we change the lives of patients for the better. And that's how we create better together. Job Title: Senior Analyst Royalties &...

  • Senior Threat Analyst

    5 days ago

    Sierra Vista, United States SOS International LLC Full time

    Overview This position is contingent upon award of contract SOS International, LLC (SOSi) is currently seeking a Senior Threat Analyst (DCO) in Fort Huachuca, AZ. The Senior Threat Analyst reports to the T&DA Team Lead and is responsible for supporting the defense of the Army Network. Essential Job Duties Responsible for leading security event monitoring and...

  • Senior Financial Analyst

    1 week ago

    lake buena vista, United States US Tech Solutions Full time

    Job Title: Senior Financial AnalystDuration: 0-12 month(s)Location: Lake Buena Vista FL 32830 United StatesWork Schedule Hybrid role; In-Office days Mon. & Tue. Description/Comment: Day to d...

  • Senior Financial Analyst

    2 weeks ago

    Lake Buena Vista, United States Vaco Technology Full time

    Vaco is Seeking a Senior Accountant to start immediately with a Fortune 500 entertainment company on a hybrid basais in Lake Buena Vista, FL. Senior Financial Analyst Job Responsibilities:- Perform month-end close procedures, including general ledger, account reconciliations, and variance analysis - Create, review, and post journal entries - Provide...

  • Grievance & Appeals Analyst

    1 week ago

    Chula Vista, United States Community Health Group Full time

    *** Gathers information and resolves customer concerns presented as a grievance or appeal. Works closely with internal departments and providers’ staff to obtain pertinent information in a timely manner and in compliance with regulatory requirements. Appropriately documents members’ grievances and appeals, the pertinent information related to the...

  • Senior Financial Analyst

    2 weeks ago

    Lake Buena Vista, United States TalTeam Full time

    Position : Senior Financial AnalystLocation : Buena Vista Florida Hybrid Direct Client RequirementDescription: Perform all Licensing Revenue accounting functions including royalty statement processing and analysis, and cash management for assigned game licensee population Perform Royalty Expense accounting functions including preparation of royalty...

  • Senior Financial Analyst

    3 weeks ago

    Lake Buena Vista, United States US Tech Solutions, Inc. Full time

    Job Title: Senior Financial Analyst Duration: 0-12 month(s) Location: Lake Buena Vista FL 32830 United States Work Schedule Hybrid role; In-Office days Mon. & Tue. Description/Comment: Day to day support and leadership with system applications and initiatives. Ability to support projects and work independently to gather requirements and...

  • Senior Financial Analyst

    1 week ago

    Lake Buena Vista, United States US Tech Solutions, Inc. Full time

    Job Title: Senior Financial Analyst Duration: 0-12 month(s) Location: Lake Buena Vista FL 32830 United States Work Schedule Hybrid role; In-Office days Mon. & Tue. Description/Comment: Day to day support and leadership with system applications and initiatives. Ability to support projects and work independently to gather requirements and...

  • Inventory Control Analyst

    1 month ago

    Vista, United States DHL Full time

    Pay Ban Range is Between $60,000-$104,000 Salary Range for Site is offering Between $70,000-$85,000 First Shift: Mon-Fri **Inventory Control Analyst** Are you a motivated, organized individual seeking a challenging and rewarding opportunity in a fast-paced environment? Would you enjoy being part of a dedicated team that works together to create a...