CCS Medical

  • Medical Call Center Compliance Analyst I

    Job Location US-FL-Clearwater
    ID
    2018-2198
    Category
    Legal/Compliance
    Position Status
    Regular Full-Time
    Position Schedule
    Monday-Friday
    Shift
    8/5
  • Overview

    Position Summary: Facilitates and administers compliance activities related to the operation of the CCS Medical Compliance Program.  Auditing, investigations, tracking and analysis of compliance activities, ongoing Compliance and regulatory education and training, and being knowledgeable of current and ongoing changes to all applicable laws, rules, regulations, and CCS Medical protocol related to compliance activities.

    Responsibilities

    • Researches, tracks and remains current on compliance, billing and other applicable laws, rules and regulations to determine their effect on CCS Medical operations, policies and procedures
    • Provides regulatory support to all areas to assure regulatory compliance and appropriate regulatory planning
    • Participates and facilitates in regulatory agency, internal, and vendor inspections and audits as needed
    • Coordinates and participates in implementing programs, policies and practices to ensure that all operating units in the company are in full compliance with State and Federal Healthcare laws as well as payer guidelines
    • Investigates and responds to internal and external customer compliance concerns in order to prevent, detect and correct improper or potentially improper activities
    • Analyzes and reports on compliance audit results and identifying areas of risk based on trends identified in the monthly internal audits, focused audits and/or external audits
    • Consults and works with department management to make recommendations or modifications on business processes based on identified areas of risk
    • Initiates and assists with implementing corrective and preventative actions as necessary to ensure compliance with standards and guidelines set forth in the CCS Medical Compliance Program and applicable local, State and Federal laws, rules and regulations
    • Reviews, drafts and revises CCS Medical Compliance Program policies and procedures
    • Coordinates and conducts educational and training activities as necessary covering the core standards of the CCS Medical Compliance Program and pertinent local, State and Federal laws, rules and regulations and private or commercial payor health care program requirements
    • Prepares and maintains internal audit files
    • Travel may be required
    • Maintains a high degree of confidentiality at all times due to access to sensitive information
    • Maintains regular, predictable, consistent attendance and is flexible to meet the needs of the department
    • Follows all Medicare, Medicaid, HIPAA, and Private Insurance regulations and requirements
    • Abides by all regulations, policies, procedures and standards

    Performance Responsibilities:

    • Exercises appropriate cost control measures
    • Maintains positive internal and external customer service relationships
    • Maintains open lines of communication
    • Plans and organizes work effectively and ensures its completion
    • Meets all productivity requirements
    • Demonstrates team behavior and promotes a team-oriented environment
    • Actively participates in Continuous Quality Improvement
    • Represents the organization professionally at all times

    Qualifications

    • Bachelor’s degree (B.A.) from four-year college or university preferred; and 2 to 3 years of compliance analyst experience or equivalent combination of education and experience
    • Certified in Healthcare Compliance (CHC) preferred
    • Read, analyze and interpret general business periodicals, professional journals, technical procedures or government regulation documents and apply that information to job functions
    • Highly organized with strong attention to detail required
    • Excellent written and oral communication skills
    • Proficient in problem solving, creativity, independent thought and sound judgment
    • Familiarity with State and Federal payer guidelines as they relate to multiple CCS Medical product lines
    • Writes clear and understandable reports and business correspondence
    • Experience conducting research online and through other mediums
    • Proficient with Word, Excel and PowerPoint
    • Good reasoning, multi-tasking abilities and time management
    • Maintains a professional, friendly manner at all times when dealing with employee-related issues
    • Facilitation/presentation, planning, organization, and execution skills
    • Judgment and decision-making and situational awareness

    Equal Opportunity Employer/Veterans/Disabled

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