Job Location Corporate Headquarters - Chula Vista, CA
Community Health Group is a locally based non-profit health plan that ensures access to high quality, culturally sensitive health care for underserved communities throughout San Diego County. We treat our 300-member, multi-lingual staff like family, encouraging an atmosphere of collaborative teamwork, continuous learning, personal growth, and promotion from within. Recognized as one of the Top Workplaces in San Diego, CHG offers its employees such benefits as tuition reimbursement, a meditation room and yoga classes, a monthly Breakfast With The CEO, and memorable events throughout the year.
We know that by serving our employees well, they, in turn, will better serve our nearly 300,000+ membership. We have been recognized consistently for the excellence and sensitivity of our customer service by members, physicians, vendors, and a full range of health care providers. We are accredited by the National Committee for Quality Assurance and proud of our continuing company-wide Quality Initiatives.
We are currently recruiting for:
TITLE: Compliance Analyst
EEO1: Administrative Support Worker
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 corrective action. Compile, track and trend audit results and recommend training and other improvement ideas to the Compliance Manager and Compliance Officer and performs related work as required. Works with the Compliance Officer, Compliance Manager and Compliance Committee in establishing and implementing an effective compliance program to prevent illegal, unethical, or improper conduct.
COMPLIANCE WITH REGULATIONS
Works closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal regulations.
- Implements and maintains established audit/control systems and policies and procedures.
- Plans, organizes and coordinates various projects and programs involving statutory, regulatory, and quantitative impact of legislation and rule-making.
- Assists in development of corporate training program related to policy and legislative matters on an as needed basis.
- Assists in the management of day-to-day operations of the compliance program.
- Monitors, and as necessary, coordinates compliance activities of other departments to remain abreast of the status of all compliance activities and to identify trends.
- Provides reports on a regular basis, and as directed or requested, keeps the Compliance Officer, Compliance Manager and Compliance Committee informed of the operation and progress of compliance efforts.
- Assists in the monitoring of the Compliance Program and related activities on a continuing basis.
- Under direction of the Compliance Officer and Compliance Manager, assists in the coordination of communication and audits with regulatory agencies.
- Provides staff support to committees or other departments, as assigned.
- Documents and maintains records of all audits performed. Records include raw data or files reviewed, report of findings, corrective action plans, reassessment, and any ongoing monitoring logs.
- Investigates, reviews, and analyzes claims data by applying knowledge of established policy, practice and by data mining techniques to determine details of fraudulent erroneous, or abusive billing activity.
- Produces a written report to summarize audit scope and findings and recommended corrective action.
- Reports any audit concerns to Compliance management without delay.
- Provides departmental education and training.
- Reassess a deficiency after a corrective action has been implemented and conducts on-going monitoring to ensure that deficiency does not reoccur.
- Oversees any monitoring functions that may be conducted by other department team members included but not limited to, monitoring for fraud, waste, and abuse.
- In concert with Compliance management, prepares documents for any external or internal audits.
- Assists in the development of new audit methodology and scope on an as-needed basis.
- Keep up-to-date with State and Federal regulations that apply to the organization.
- Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
- Contributes to the team effort by accomplishing related results as needed.
- Maintains product and company reputation and contributes to the team effort by conveying professional image and accomplishing related tasks; participating on committees and in meetings; performing other duties as assigned or requested.
- Performs other duties as assigned.
- Bachelor’s Degree Preferred
- Two or more years’ experience in auditing, compliance, legislative affairs, regulatory affairs, or public policy analysis preferred.
- Two or more years in managed care setting.
- Advanced knowledge of Microsoft Word, Excel, PowerPoint and Outlook.
- Customer service skills with the ability to interact professionally and effectively with staff from all departments within and outside the Company. Excellent verbal, written, organizational, and analytical skills.
- Understanding of federal, State, and local legislative and regulatory processes.
- Ability to handle confidential, sensitive information with professionalism
- Must have a track record of producing work that is highly accurate, demonstrates attention to detail, and reflects well on the organization
- Demonstrated ability to utilize and apply internal auditing principles, practices, and techniques.
- Ability to organize and prioritize work effectively; detail oriented; apply established policies procedures and guidelines for problem-solving and decision making.
- Some traveling may be required.
- Prolonged periods of sitting
- Prolonged use of computer.
- May be required to work evenings, weekends, and holidays.
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.
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