Compliance Analyst
at RCM Health Care Services

Date Posted: 4/8/2019

Job Description

Position Summary
 
Compliance Analyst
 
Work under the direction of the Compliance Officer/departmental team and in collaboration with business units. Minimum bachelor's degree and relevant experience; possess strong leadership and organizational skills with impeccable integrity; ability to work independently and produce strong outcomes and timely deliverables; excellent verbal and written communication skills; strong data analysis ability and computer skills.
 
Responsibilities
 
  • Work independently on assigned projects to ensure health plan compliance with Medicare and NYS Medicaid regulatory requirements.
  • Review OIG and OMIG requirements and best practices for compliance program; review and update compliance materials.
  • Participate in audits and ongoing monitoring or investigations, such as appeals and grievance, provider relations and contracting, and other functions to ensure compliance with governmental regulations and plan policies; prepare reports and propose solutions to issues.
• Assist with preparation and review of plan marketing materials, and provide timely, comprehensive feedback to operational owners regarding required changes.
• Assist in contract processing and ad-hoc projects.
  • Maintain proficiency in contract and credentialing, appeals and grievances, sales and marketing, enrollment and other regulations necessary to perform duties and responsibilities.
• Maintain working knowledge of HIPAA and NYS privacy regulations.
• Communicate and collaborate with business units on reporting submissions and resolution of issues and foster positive working relationships.
• Manage provider exclusion process and database, and provide ongoing updates.
• Support the Compliance Officer/department; maintain current files on compliance issues to ensure complete follow-up and recordkeeping documentation.
• Draft P&Ps based on regulatory changes and/or internal processes.

Job Snapshot

About Us

RCM Health Care Services offers career defining opportunities to candidates from the leading employers in health care. Whether you’re looking for a new job or seeking to hire the best medical talent, RCM Health Care Services has the solution for you. Since 1975, we’ve established ourselves as a leader in the recruitment industry by connecting thousands of healthcare professionals with placements that support their needs. If you’re looking to make the next move in your career, let RCM be your guide, we’re with you every step of the way!

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