Internal Analyst

The Hospital Authority of Miller County•Colquitt, GA

About The Position

The Internal Analyst performs financial, operational, compliance, and/or investigative audits for the Health System and related entities. The position reviews the effectiveness of internal controls, analyzes records, reports, regulations, and operating practices, and prepares timely audit and regulatory-control reports, findings, conclusions, and recommendations. It also supports the organization’s Compliance Program and risk-based compliance audits, investigates complaints and reconsiderations, and prepares written responses and case summaries for review and determination. The role works with internal departments, members, providers, and external agencies to research issues, obtain information, and resolve complaints, grievances, reconsiderations, and appeals. The analyst is expected to handle complex issues, changing priorities, multiple projects, and deadlines while maintaining strong organization, attention to detail, sound judgment, confidentiality, and professional working relationships. All duties must align with the organization’s mission, vision, values, policies, and applicable laws and regulations, including HIPAA and ERISA.

Requirements

High school diploma or equivalent.
Intermediate skills with Microsoft Word, Excel, and PowerPoint.
Critical-thinking skills and strong attention to detail.
Ability to communicate in English verbally and in writing.
Strong written and verbal communication skills.
Ability to analyze and resolve complex issues.
Excellent organizational, problem-solving, and analytical skills to support sound, timely decisions.
Ability to manage changing priorities and assignments across multiple projects and deadlines.
Ability to prioritize workload effectively and stay organized.
Familiarity with Medicaid and Medicare claims denials and appeals processing.
Knowledge of HIPAA guidelines.
Ability to maintain patient confidentiality and comply with applicable laws, regulations, and organizational policies.

Nice To Haves

Bachelor’s degree in Business, Accounting, Health Care Administration, or a related field.
Healthcare compliance experience or certification.
Healthcare billing or coding experience.
Additional language skills.

Responsibilities

Perform financial, operational, compliance, and/or investigative audits of the Health System and related entities.
Review and assess the effectiveness of internal controls.
Prepare and communicate audit findings, conclusions, and recommendations in a timely manner.
Assist in developing, maintaining, and revising policies and procedures for the Compliance Program and related activities.
Support an effective Compliance Program, including promotion of Corporate Standards of Conduct and the Corporate Code of Ethics.
Maintain an understanding of new and existing compliance issues and related policies and procedures.
Work with internal departments to research and resolve member and provider reconsiderations and grievances.
Contact members, providers, and external agencies to obtain information needed to resolve and respond to reconsiderations and grievances.
Prepare accurate written responses to complaints that address each complainant’s issues.
Prepare investigation cases detailing findings for consideration in the Plan’s determination.
Analyze records, reports, regulations, and operating practices, and prepare reports on regulatory-control adherence.
Implement and maintain comprehensive risk-based compliance audits.
Collaborate and communicate appropriately with other departments and affiliates to maintain positive working relationships.
Maintain current knowledge in areas of responsibility, attend required meetings and educational programs, and complete mandatory training and competency evaluations.
Protect patient confidentiality and use role-based access to electronic protected health information only as needed for job functions.
Report suspected illegal or unethical behavior to a supervisor or the Compliance Officer.