Community Health Group is a locally based non-profit health plan that ensures access to high quality, culturally sensitive health care for underserved communities throughout San Diego County. We treat our 300-member, multi-lingual staff like family, encouraging an atmosphere of collaborative teamwork, continuous learning, personal growth, and promotion from within. Recognized as one of the Top Workplaces in San Diego, CHG offers its employees such benefits as tuition reimbursement, a meditation room and yoga classes, a monthly Breakfast With The CEO, and memorable events throughout the year.
We know that by serving our employees well, they, in turn, will better serve our nearly 300,000+ membership. We have been recognized consistently for the excellence and sensitivity of our customer service by members, physicians, vendors, and a full range of health care providers. We are accredited by the National Committee for Quality Assurance and proud of our continuing company-wide Quality Initiatives.
We are currently recruiting for:
TITLE: Compliance Analyst
EEO1: Administrative Support Worker
Conducts internal audits of all departments and oversees internal monitoring activities conducted by others to determine that core department activities are in compliance with established management control systems, provides analysis and reports of audits to Compliance Manager and works with Compliance department to implement and monitor corrective action. Compile, track and trend audit results and recommend training and other improvement ideas to the Compliance Manager and Compliance Officer and performs related work as required. Works with the Compliance Officer, Compliance Manager and Compliance Committee in establishing and implementing an effective compliance program to prevent illegal, unethical, or improper conduct.
COMPLIANCE WITH REGULATIONS
Works closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal regulations.
- Implements and maintains established audit/control systems and policies and procedures.
- Plans, organizes and coordinates various projects and programs involving statutory, regulatory, and quantitative impact of legislation and rule-making.
- Assists in development of corporate training program related to policy and legislative matters on an as needed basis.
- Assists in the management of day-to-day operations of the compliance program.
- Monitors, and as necessary, coordinates compliance activities of other departments to remain abreast of the status of all compliance activities and to identify trends.
- Provides reports on a regular basis, and as directed or requested, keeps the Compliance Officer, Compliance Manager and Compliance Committee informed of the operation and progress of compliance efforts.
- Assists in the monitoring of the Compliance Program and related activities on a continuing basis.
- Under direction of the Compliance Officer and Compliance Manager, assists in the coordination of communication and audits with regulatory agencies.
- Provides staff support to committees or other departments, as assigned.
- Documents and maintains records of all audits performed. Records include raw data or files reviewed, report of findings, corrective action plans, reassessment, and any ongoing monitoring logs.
- Investigates, reviews, and analyzes claims data by applying knowledge of established policy, practice and by data mining techniques to determine details of fraudulent erroneous, or abusive billing activity.
- Produces a written report to summarize audit scope and findings and recommended corrective action.
- Reports any audit concerns to Compliance management without delay.
- Provides departmental education and training.
- Reassess a deficiency after a corrective action has been implemented and conducts on-going monitoring to ensure that deficiency does not reoccur.
- Oversees any monitoring functions that may be conducted by other department team members included but not limited to, monitoring for fraud, waste, and abuse.
- In concert with Compliance management, prepares documents for any external or internal audits.
- Assists in the development of new audit methodology and scope on an as-needed basis.
- Keep up-to-date with State and Federal regulations that apply to the organization.
- Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
- Contributes to the team effort by accomplishing related results as needed.
- Maintains product and company reputation and contributes to the team effort by conveying professional image and accomplishing related tasks; participating on committees and in meetings; performing other duties as assigned or requested.
- Performs other duties as assigned.