Healthcare Compliance Analyst
- Researching, interpreting, and implementing federal, state, and local regulatory mandates
- Working as the liaison to management to ensure regulatory compliance with applicable laws, regulations, policies, grants, and contracts
- Preventing, detecting, and correcting inappropriate activity or misconduct, including health care fraud, waste, and abuse
- Implementing effective lines of communication with DHS staff to report inappropriate activities or misconduct
- Tracking and identifying trends in reported compliance issues and inquiries
- Conducting investigations of alleged misconduct and reporting to outside entities when applicable
- Conducting audits to ensure compliance with health care laws, regulations, policies, and grant requirements
- Developing health care compliance policies, procedures, and Standards of Conduct
- Creating and implementing regular health care compliance training and education
- Assisting in regular Compliance Program risk assessments
- Participating in the Compliance Program Governance oversite committee
- Ensuring applicable contractors have a compliance program according to contracts and regulations
- Helping to promote a culture of honest and responsible behavior
- Familiarity with mental health laws and regulations regarding Medicare and Medi-Cal
- Superior analytical skills to research, interpret, and implement federal, state, and local regulatory mandates
- Advanced writing, communication, collaboration, and problem-solving skills
- The ability to deliver presentations and use public speaking skills
- Experience using evaluation methodologies, including principles and practices related to continuous quality improvement
- Experience developing and implementing training programs
- The demonstrated ability to diplomatically respond to difficult and stressful situations
- An eye for detail and an aptitude for managing and prioritizing multiple responsibilities and projects
- The ability to adapt to change, and communicate information and ideas clearly and concisely
- Certification in Health Care Compliance (CHC), Healthcare Privacy Compliance (CHPC), or another compliance certification
- Proficiency in Microsoft Office
- Experience with data analytics (highly desired).
Education: Academic work which directly relates to the knowledge and abilities listed. Normally, graduation from an accredited school nursing, academic course work in health care, hospital or nursing administration, medical records, psychology counseling or social work or a related field will meet these required knowledge and abilities.
Experience: Any combination of training and experience that will provide an opportunity to acquire the knowledge and abilities listed. Normally, three years of experience in an acute care hospital or other equally responsible health profession experience including some training or experience in performing patient's rights advocacy, utilization review or quality assurance or infection control or experience analyzing health care or nursing systems and programs could provide this opportunity.
License: Possession of a valid California license as a Registered Nurse or license, registration or certification in another related health discipline.
Knowledge, Skills, and Abilities
Thorough knowledge of: relative importance of problems effecting the respective
areas of responsibility.
Considerable knowledge of: various methods of assessing professional care and services; the applicable laws, rules, regulations and regulatory agency requirements related to assigned area of responsibility; medical terminology, hospital routines, and policies and procedures.
Working knowledge of: the various specialty areas within the Resource Management Program.
Knowledge of: appropriate financial reporting and statistical design, methodology, presentation and interpretation; the principles and practices of consultation and training.
Ability to: recognize resource management and patient care problems or potential problems in their early stages; utilize various methods of assessing the utilization and quality of services and care provided; communicate effectively with persons of varying backgrounds; influence physicians, staff, other managers into accepting changes required by the resource management program; advocate on behalf of patients and clients using behavior that will provide the best opportunity for a reasonable resolution of the complaint; establish and maintain cooperative working relationships with other hospital and Mental Health Department personnel and others who have an interest in quality patient care; exercise responsibility, initiative, ingenuity, independent analysis and judgment in solving medical, administrative and management problems; write comprehensive reports; analyze problems accurately and to take effective course of action; give and follow oral and written directions of a technical and professional nature in detail; interact with patients and professional staff sympathetically and tactfully in difficult and sensitive situations; establish and maintain cooperative working relationships with other hospital personnel; interpret medical charts, records and reports.
Selection Procedure & Some Helpful Tips When Applying
- Your application information and your responses to the supplemental questions are evaluated and taken into consideration throughout the entire selection process.
- You should list all employers and positions held within the last ten years in the work history section of your application. Be as thorough as possible when responding to the supplemental questions.
- You may include history beyond ten years if related to the position for which you are applying. If you held multiple positions with one employer, list out each position separately.
- Failure to follow these instructions may impact your competitiveness in this process or may result in disqualification.