Compliance Analyst (On-site)

Management Resources Group LLC (MRG)•Schertz, TX

9h•Onsite

About The Position

The Compliance Analyst position is responsible for supporting the Compliance Department in developing, implementing, and administering the continuity of the collective corporate compliance and accreditation programs. This role contributes to key compliance initiatives and organizational objectives. The Compliance Analyst is an essential part of the communication of regulatory and legal compliance within the Utilization Management industry. This role will work in collaboration with all members of the Compliance team, as well as all Nexus and ProPeer business leaders and staff, to develop, implement, and evaluate departmental goals, strategies, programs, and projects that support the continuous improvement process within the Utilization Management and Independent Review arena. The Compliance Analyst acts as an integration and dissemination analyst to transfer knowledge and mobilize key tactics for improvement project activities. This role contributes to the process of developing, executing, driving, and communicating the results of the organization’s Compliance Program for improvement and key collaborative initiatives within budget and assigned deadlines.

Requirements

Knowledge of utilization review processes and managed care
Knowledge and experience using continuous improvement/Lean methodologies and processes
Ability to work proactively under tight timelines and budgets
Ability to coordinate compliance activities involving several departments and processes simultaneously
Demonstrated ability to problem-solve complex, multifaceted situations
Ability to maintain a professional manner and function with all levels of management
Ability to conduct meetings, compliance training sessions, and other compliance-related activities
Ability to demonstrate strong communication, interpersonal, analytical, writing, presentation, self-motivation, broad thinking, and business skills
Strong organizational and task prioritization skills
Strong analytical, numerical, and reasoning abilities
Strong attention to detail and a thorough understanding of regulatory requirements
Ability to establish credibility and be decisive – but able to recognize and support the organization’s preferences and priorities
Project Management experience or ability; awareness of current and emerging trends in project management technologies, techniques, issues, and approaches
Competence in both oral and written English
Ability to establish and maintain effective and harmonious work relationships with team members, physician panel members, state regulators, clients, and vendors
Proficiency using Microsoft Windows, Word, Excel, and PowerPoint

Nice To Haves

Preferred experience with the elements of an effective compliance program, as well as accreditation bodies such as URAC and NCQA
Prefer at least 3 years’ experience in the healthcare compliance environment of an accredited organization
Previous auditing and/or entity accreditation experience preferred
Bachelor’s degree in health information management, health administration, business administration, public administration or related field is preferred
Willing to obtain various compliance-based certifications within the industry.

Responsibilities

Performs and completes audits to meet client, regulatory, and accreditation requirements
Assists in the development, drafting, and maintenance of the company’s collective policies, procedures, and best practices documentation
Develops audit and monitoring tools for compliance-related activities
Analyzes potential risks and areas of non-compliance to improve organizational practices
Monitors developments and changes in federal, state, and local statutes and regulations to assess the impact on the organization and recommends implementation and compliance strategies
Tracks applicable licensing, laws, and regulations in the jurisdictions where the organization conducts business, and that might affect the organization’s policies and procedures
Maintains current knowledge of accreditation, regulatory compliance, and licensure requirements
Understands and is responsible for any regulatory or accreditation reporting requirements
Ability to understand, interpret and critically apply regulatory requirements to the organization’s operations by preparing a gap analysis report that will highlight gaps and provide potential solutions
Creation, revision, and editing of Compliance policies and procedures under the direction of the Director, Compliance and Senior Vice President, Compliance
Responsible for updating, facilitating, and tracking ongoing compliance training and education both internally and externally
Provides logistical and operational support for key compliance entities and initiatives (e.g., Quality Management Committee)
Provides input for the Compliance Department’s Work Plan and risk assessments
Monitors and reports on anonymous feedback regarding the organization’s compliance processes
Assists in the administration of the company’s compliance and accreditation programs
Promotes adherence to the organization’s Compliance Programs
Provides support for ad hoc projects, assignments and other initiatives as needed
Experienced in leading committees, activities, and staff
Oversees and leads specific projects and project teams as needed
Other duties as assigned by the Director, Compliance and Senior Vice President, Compliance