Compliance Program Analyst Jobs

FLSA Status

Job Role Summary

The Compliance Program Analyst is a valuable team member of the Office of Corporate Compliance, providing expertise and analysis in response to external audits, self-audits, processes and functions to ensure compliance with federal and state laws. This role includes assessing risks, identifying trends, developing and executing appropriate tests of controls, presenting results and recommendations for improvements to management, and drafting audit reports.

Essential Functions and Responsibilities

• Supports implementation of the risk assessment plan, and ensures timely follow up and completion of activities included in the plan including external audits, internal audits, ongoing monitoring, special projects, education and training.
• Prepares audit reports summarizing findings with recommendations for improvement and corrective actions where identified.
• Develops education and training to department under review as well as physician groups that explains gap areas identified and clarifies the regulations pertaining to the specific services provided.
• Stays current with changes in CMS documentation and reimbursement policies to assist with the development of audit plans for both scheduled and unscheduled audits and investigations.
• Collaborates with revenue cycle and finance to review coding and billing areas of risk, generating reports to the department area reviewed.
• Monitors corrective action plans initiated as a result of an audit or special project, assisting the department with implementation of the corrective action plan and providing guidance as needed.
• Evaluates the effectiveness of policies and procedures and the effectiveness of internal controls.
• Assists with government investigations, including efforts to conduct interviews and review relevant documents.
• Expertise with audit processes and functions to ensure compliance with federal and state laws. This includes assessing risks, identifying trends, developing and executing appropriate tests of controls, presenting results and recommendations for improvements to management, and drafting audit reports.

Job Requirements

• Bachelor’s degree preferred, or five years of relevant experience in audit of health care services.
• Five years of legal, regulatory, or compliance experience; direct experience within a public agency or healthcare setting strongly desired.
• Health Care Compliance certification desired but not required.