Compliance Analyst, Bakersfield, CA

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Compliance Analyst

Kern Family Health Care, 2900 Buck Owens Blvd., Bakersfield, California, United States of America Req #1905

We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization. Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).

KHS reasonably expects to pay starting compensation for the Compliance Analyst position in the range of $35.50- $47.48 / Hourly

Our Mission.. Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.

Definition

Under the direction, of the Compliance Manager, this position is responsible for analytical compliance and business-related activities including the generation and analysis of reports into professional compliance documents.

Distinguishing Characteristics

The Compliance Analyst will work closely with the Compliance Manager in order to develop business process improvement recommendations based on findings from both internal and external audits. Strong verbal and written communication skills are required for communicating at all levels within the company. Critical thinking and the ability to deal with both qualitative and quantitative information to develop professional materials for internal customers is essential. This position may require interaction with KHS Stakeholders from time to time.

Essential Functions

• Assists in the monitoring of existing and proposed regulations to ensure adequate operational compliance of the Plan with changing healthcare requirements.
• Works on process improvement projects related to audit findings or business controls issues.
• Performs monitoring of subcontractor to ensure compliance contract requirements.
• Performs analysis of claims data as assigned for the identification of potential provider fraud, waste, or abuse.
• Ability to organize meetings and capture meeting action items (Compliance Committee, Fraud, Waste and Abuse Committee, and Delegated Oversight Committee) meetings in a software solution.
• Strong Microsoft proficiency using MS Office Suite: Word, Excel, Outlook, and PowerPoint.
• Knowledge of general project planning, coordination, and administrative practices.
• Assists in the review and determination of the reliability of management data developed with-in the organization.
• Coordinates, prepares and monitors special projects and reports as required.
• Generates ad hoc reporting for the Compliance Department.
• Conducts mock audits.
• Evaluates Business Associates HIPAA Privacy and Security compliance efforts Builds and distributes report to company stakeholders on HIPAA Privacy and Security compliance current state and suggested efforts.
• Assesses existing internal systems and recommends technical improvements (e.g., performance upgrades).
• Recommends, establishes business case, and assists management and others in building acceptance of new proposed APLs and procedures.
• Conduct quarterly privacy reviews to confirm compliance with required safeguards.
• Works with the Compliance Manager in business development efforts and recommended training and team development activities.
• Review KHS Anti-Fraud Plan for regulatory or process changes.
• Coordinate completion KHS Anti-Fraud Plan changes for submission to the Department of Managed Health Care.
• Review and update annual all employee FWA, HIPAA, and Code of Conduct training.
• Participate in regulatory FWA meetings and webinars and lead action needed in response to these sessions.
• Create, maintain and update FWA language for inclusion in materials such as the Compliance Corner, Member Handbook, or provider communications in concert with Directors of these Departments.
• Complete timely review and disposition of referrals and inquiries in coordination with internal stakeholders.

Other Functions

• Ability to work effectively and efficiently in a deadline-driven environment.
• Adheres to all company policies and procedures relative to employment and job responsibilities.
• Other duties as assigned.

Employment Standard:

Education:

Associates Degree or equivalent. Bachelor’s degree in Health Services Administration from an accredited institution or equivalent; AND four (4) years’ experience within the financial, claims, legal or regulatory support preferably in the health care industry.

OR

Experience:

Six (6) years’ experience within the financial, claims, legal or regulatory support preferably in the health care industry.

Five years (5) Experience in health insurance and HMO compliance is highly desirable.

Knowledge of:

Claims, Utilization Management, and other health plan departmental processes and procedures; project management process; reporting tools and analysis, report generation, implementation of business controls.

Ability to:

Adapt to a rapidly evolving work environment; work independently and manage multi-task responsibilities; work well and communicate with a variety of personnel and providers.

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.

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