Medicare Compliance Analyst – Great Health Organization -100% remote

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Work from home Full-time Health insurance
Job highlights
Qualifications
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Bachelor’s degree in business, health care or related area or equivalent job experience
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2-4 years of experience working in a healthcare or other highly regulated environment; or other relevant specialized experience, training or education
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Competent in SQL, Access, Word, Excel & PowerPoint
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Ability to execute queries
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Proficient competences with data analytics, data accuracy, QC & data integrity
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Excellent interpersonal, verbal and written communications skills
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Fluency in Microsoft Office
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Strong ability to develop and implement tracking tools for regulatory memos including dashboard, graphs, flow charts and other visual aids
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Possess excellent communication skills with the ability to write clearly and concisely and interact with a wide range of professional levels
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Time management and organizational skills are an extremely important aspect to this position due to the strict deadlines imposed by government agencies
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Strong attention to detail a must
Responsibilities
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This position is to support our Medicare compliance program effectiveness through data analysis to identify risks, trends by using data visualization and dashboards to portray information to department leadership, Compliance Committee, and Audit & Compliance Committee of the Board
•
Paramount to this position is the current monthly Medicare Dashboard; its data accuracy, presentation/optics, timeliness, including all information provided by vendors, must be flawless
•
This position is responsible for completing all departmental reporting and project related tasks accurately and within all required timeframes
•
Perform departmental reporting and analyze data for trending, issue resolution, and opportunities for efficiencies
•
Use SQL and Access to run queries/reports and ensure integrity of the data
•
Understand data sources and the data to complete the reports and analyze the data with management
•
Execute departmental reports at the required frequency with implemented quality check workflows
•
Analyze and review data on a regular basis to ensure compliance and consistency
•
Communicate data outliers to business owners, leadership and Medicare Programs management
•
Complete simple ad hoc reporting/queries for as needed and coordinated with management staff
•
Special projects as assigned
•
Maintain and improve systems and processes to support our Medicare compliance program and departmental activities, especially concerning the monthly Medicare Dashboard
•
Understand, use, and translate data, including mastery of all required Program Audit universes
•
Analyze department and program information/data to identify trends and risks; report identifying risks and trends back to the business for action
•
Convert complex subject matter to accessible information for all colleagues
•
Support and execute program activities
•
Leverage technology to support assigned program activities
•
Maintain documentation of program activities
•
Maintain time sensitive processes and meet organizational deadlines
•
Perform data analysis and validation to ensure required accuracy and specifications
•
Engage with internal business areas and vendors as needed to address issues identified to ensure compliance with audit protocols
•
Understand And Communicate About What We Do And Why
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Develop working understanding of organizational structure to enhance our Medicare compliance program
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Collaborate with colleagues with the ability to work across departments with a collaborative, responsive, respectful approach
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Communicate effectively with internal and external partners
Job description
US-MA-Worcester Job ID: 6775 Type: Full Time # of Openings: 1 Category: Corporate Compliance Fallon Health – Corp HQ Overview About Fallon Health Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit . Summary This position is to support our Medicare compliance program effectiveness through data analysis to identify risks, trends by using data visualization and dashboards to portray information to department leadership, Compliance Committee, and Audit & Compliance Committee of the Board. Individuals with strong organizational, technical, data visualization and reporting skills are encouraged to apply. Paramount to this position is the current monthly Medicare Dashboard; its data accuracy, presentation/optics, timeliness, including all information provided by vendors, must be flawless. This position is responsible for completing all departmental reporting and project related tasks accurately and within all required timeframes. The incumbent must have excellent organizational skills, understand the importance of regulatory and other reporting requirements, be professional at all times, be flexible and have the ability to multi-task, and prioritize work accordingly to ensure the accuracy and integrity of reports. Responsibilities Perform departmental reporting and analyze data for trending, issue resolution, and opportunities for efficiencies • Use SQL and Access to run queries/reports and ensure integrity of the data. • Understand data sources and the data to complete the reports and analyze the data with management. • Execute departmental reports at the required frequency with implemented quality check workflows. • Analyze and review data on a regular basis to ensure compliance and consistency. • Communicate data outliers to business owners, leadership and Medicare Programs management. • Complete simple ad hoc reporting/queries for as needed and coordinated with management staff. • Special projects as assigned Identify opportunities to innovate • Maintain and improve systems and processes to support our Medicare compliance program and departmental activities, especially concerning the monthly Medicare Dashboard • Understand, use, and translate data, including mastery of all required Program Audit universes • Analyze department and program information/data to identify trends and risks; report identifying risks and trends back to the business for action • Convert complex subject matter to accessible information for all colleagues Support and execute program activities • Leverage technology to support assigned program activities • Maintain documentation of program activities • Maintain time sensitive processes and meet organizational deadlines • Perform data analysis and validation to ensure required accuracy and specifications • Engage with internal business areas and vendors as needed to address issues identified to ensure compliance with audit protocols Understand And Communicate About What We Do And Why • Develop working understanding of organizational structure to enhance our Medicare compliance program • Collaborate with colleagues with the ability to work across departments with a collaborative, responsive, respectful approach • Communicate effectively with internal and external partners • Be self-motivated, take initiative and engage in critical thinking while being task-oriented, with excellent follow through, patience and persistence Possess excellent analytical and creative problem-solving abilities, a strong commitment to accuracy and attention to detail Aptitude to work in a fast-paced environment, adapt to changing conditions, and meet deadlines Qualifications • Bachelor’s degree in business, health care or related area or equivalent job experience • 2-4 years of experience working in a healthcare or other highly regulated environment; or other relevant specialized experience, training or education • 2 years Medicare Advantage experience preferred • PACE requirements knowledge a plus • Competent in SQL, Access, Word, Excel & PowerPoint. Ability to execute queries. Proficient competences with data analytics, data accuracy, QC & data integrity. Excellent interpersonal, verbal and written communications skills. • Fluency in Microsoft Office. Strong ability to develop and implement tracking tools for regulatory memos including dashboard, graphs, flow charts and other visual aids. Possess excellent communication skills with the ability to write clearly and concisely and interact with a wide range of professional levels. Time management and organizational skills are an extremely important aspect to this position due to the strict deadlines imposed by government agencies. Strong attention to detail a must.
January 3rd, 2023 by