Healthcare Compliance Analyst
2 weeks ago
Overview: The ongoing challenges in the realm of affordable healthcare present significant opportunities for growth and innovation. At Metropolitan Jewish Health System, we are committed to enhancing our services to meet the evolving needs of our patients and members.
Position Summary: Under the guidance of the Compliance Officer and the Compliance Department leadership, the Compliance Auditor plays a crucial role in independently managing designated projects to ensure adherence to Medicare (Part C and D), New York State Medicaid, and Managed Long-Term Care (MLTC) regulations.
Key Responsibilities:
- Conduct audits and monitoring activities across various health plan operations, including but not limited to appeals and grievances, claims processing, medical management, customer service, provider relations, contracting, sales, and enrollment.
- Ensure compliance with governmental regulations and internal health plan policies.
- Develop and implement comprehensive audit plans, protocols, corrective action strategies, root cause analyses, and impact assessments.
- Engage effectively with all levels of management and liaise with federal and state regulatory bodies.
Qualifications:
- A Bachelor's Degree is required.
- A minimum of three years of auditing experience is essential.
- Experience in compliance within the healthcare sector, particularly with Medicare and Medicaid managed care, is advantageous.
- Familiarity with facilitating regulatory audits, including those conducted by CMS, DOH, and DFS, is preferred.
- Strong analytical skills with proficiency in Excel, including data analysis, charting, and dashboard creation.
- Exceptional verbal and written communication skills are critical.
- Ability to work independently and collaboratively in a dynamic environment.
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