INTERNAL ANALYST

The Hospital Authority of Miller County•Colquitt, GA

About The Position

The Internal Analyst performs financial, operational, compliance, and/or investigative audits of the Health System and related entities. The role reviews the effectiveness of internal controls, analyzes records, reports, regulations, and operating practices, and prepares timely audit findings, conclusions, recommendations, and reports on regulatory control adherence. The position is responsible for implementing and maintaining comprehensive risk-based compliance audits and supporting an effective Compliance Program, including promoting the organization’s standards of conduct and code of ethics. It also investigates complaints, grievances, and reconsiderations, gathers information from members, providers, departments, and external agencies, and prepares accurate written responses and case findings for consideration of the Plan’s determination. The position requires sound judgment, strong writing and communication, attention to detail, and the ability to analyze and resolve complex issues, prioritize changing assignments, and complete multiple projects on time. The Internal Analyst collaborates with other departments and affiliates while maintaining positive working relationships and complying with applicable laws, regulations, organizational policies, confidentiality requirements, and the organization’s mission and values. Duties may be reassigned, and other duties may be required. The role requires a high school diploma or equivalent. A bachelor’s degree in Business, Accounting, Health Care Administration, or a related field is preferred. Healthcare compliance experience or certification, and healthcare billing or coding experience, are also preferred. Intermediate Microsoft Word, Excel, and PowerPoint skills, basic computer skills, critical thinking, attention to detail, and strong English verbal and written communication skills are required. Additional languages are preferred. The work environment is generally a well-lighted, air-conditioned area with moderate noise. Exposure to high noise levels, bright lights, limited hazardous substances or body fluids, or infectious organisms may occur. Work may involve changing tasks, periods of high stress and fluctuating workloads, and overtime as needed. Physical demands include standing and walking continuously; bending, stooping, pushing, pulling, and lifting or carrying loads frequently; and sitting, climbing, twisting, reaching above the shoulder, and certain assisted lifting tasks occasionally.

Requirements

High school diploma or equivalent.
Intermediate skills with Microsoft Word, Excel, and PowerPoint.
Basic computer skills.
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 and willingness to manage changing priorities and work 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.
Ability to complete work within designated time and attend required training and meetings.

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 organizational internal controls.
Prepare and communicate audit findings, conclusions, recommendations, and reports on regulatory control adherence in a timely manner.
Implement and maintain comprehensive risk-based compliance audits.
Assist in developing, maintaining, and revising Compliance Program policies and procedures to prevent illegal, unethical, or improper conduct.
Support an effective Compliance Program, promote corporate standards of conduct and the code of ethics, and maintain understanding of compliance issues and related policies and procedures.
Work with internal departments to research and resolve member and provider reconsiderations, complaints, 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 cases documenting investigation findings for consideration of the Plan’s determination.
Analyze records, reports, regulations, and operating practices.
Collaborate and communicate appropriately with other departments and affiliates to maintain positive working relationships.
Manage changing priorities, assignments, projects, and deadlines; prioritize workload effectively and stay organized.
Maintain patient confidentiality and comply with applicable laws, regulations, organizational policies, and ethical business practices.
Complete required training, in-services, evaluations, and other job and professional requirements.
Perform other duties as required.