Compliance Analyst

Job Description

Job Description

Our Compliance Analyst is responsible for management of daily operational and regulatory requirements within the Compliance department. The primary goal of this position will be designing, conducting and presentation of internal audits and results, according to the annual Compliance Work and Audit Plan. Using results analysis for identification and mitigation of organizational risks, detailed documentation, objective investigation, and fact-based recommendation for all compliance processes related to internal controls and safeguards associated with Stark and Anti-Kickback Statutes and Fraud, Waste and Abuse, inclusive of False Claims Act. Additional responsibilities may include and overlap with safeguards associated with Privacy.

*THIS IS A HYBRID POSITION. Candidates must be able to commute to the office in Boothwyn. Commute can be up to an hour and a half from our office.

Essential Job Duties

Manages the full life cycle (develops, conducts, presents and educates) of detailed internal audits in accordance with policy and the annual Corporate Compliance Work and Audit Plan. Includes, but not limited to the following essential responsibilities: 

• Research and gather appropriate documentation or other information needed to complete the audit with accuracy and efficiency, while maintaining audit scope.
• Develop and present timely internal audit report findings to VP of Corporate Compliance with the ability to professionally and effectively support opinion, recommendations and outcomes. Analyze audit findings against applicable compliance standards, organizational policies and procedures, and federal, state and local laws, statutes and regulations;
• Challenge the reliability of financial reports, records and/or safeguarding of assets.
• Maintains scheduling and performs internal audits according to audit plans and OIG Guidance for Medicare, Medicaid and other third-party payer documentation pertaining to coding, billing, documentation, reimbursement and other internal financial and operational activities.
• Seek collaboration and/or input from manager, as needed, to ensure accuracy, reliability and objectivity throughout the course of the audit.
• Manages and participates in processes for documenting and investigating hotline and internal concerns raised regarding business ethics, Stark Law, Anti-Kickback Statutes and Fraud, Waste and Abuse.
• Takes the lead on ensuring that effective corrective action/remediation plans are implemented timely, including training/re-training of staff has taken place.
• Ensures investigation documents are thoroughly reviewed and approved according to the government requirements, organizations policy and procedure and maintained in accordance with approved format and structure.
• Maintains ComplyTrack® system for audits, tasks, projects, and compliance related issues; identifies potential areas of compliance vulnerability and risk; facilitates corrective actions plans for issues to be resolved.
• Actively participates with educational development and training related to Compliance Program, including onboarding of new hires. Participates, as needed, with on-site and off-site educational presentations, financial audits and/or investigations.
• Serve as subject matter expert (SME) and resource for corporate staff, field and clinical areas on matters related to regulatory compliance on fiscal and operational compliance matters within assigned area of responsibility.
• Supports needs associated with privacy, medical records requests and exclusion screening, as needed.
• Establish effective intra- and inter-departmental communication while consistently demonstrating a professional and high standard of conduct, ethics, objectivity, judgment, independence, and discretion.
• Limited Travel may be required for national and regional events and educational opportunities.

*Other job duties and special projects as assigned.

Ideal Candidate Will Have

• High School diploma or equivalent with three or more years’ experience in healthcare setting (i.e. hospital, homecare, pharmacy etc.).
• High degree of knowledge of medical billing or statistical analysis. Experience working within CMS related guidelines.
• Ability to maintain confidentiality and demonstrate high degree of integrity.
• Proficiency in MS Office, especially Word, Excel, and PowerPoint, with a focus on creating and developing spreadsheets, presentations, and reports effectively and efficiently.
• Ability to work independently while handling multiple projects and tasks concurrently and timely. Strong written and oral communication and interpersonal skills. Proficient in proofreading, spelling and grammar skills.
• Excellent organizational, investigative and problem-solving skills. Ability to maintain professionalism in difficult and stressful situations.
• Willingness and ability to achieve compliance certification within first 2 years of hire and maintain during tenure of employment.
• Ability to effectively speak in front of small groups and all to front line employee audiences including Onboarding presentation.

Physical Requirements The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee may be required to travel (depending on role), stand, sit, walk, see, hear, use hands and fingers regularly, handle, or feel objects, tools, or controls, and reach with hands and arms. 

Salary Range: $68,000-72,000 annual

Pentec Health offers a comprehensive compensation and full benefits package. Actual pay will be based on several factors such as qualifications and skills for the role plus geographic location. Benefits may include but are not limited to medical, dental, vision, 401k match, PTO, paid holidays, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.