Compliance Analyst

About the role

The Legal team at Integra Partners works cross-functionally to help achieve our mission of reducing friction in healthcare. We are committed to working collaboratively, transparently, and efficiently to provide exceptional legal and compliance services to our internal stakeholders, health plans, and providers. We are committed to excellence in our work, a growth mindset and continuous improvement, and cultivating a deep understanding of the healthcare industry.

We are hiring a Compliance Analyst to be an integral member of the Legal team and ensure we meet and exceed all our compliance obligations. In this role, you will bring your previous compliance experience and knowledge to monitor for FWA issues and investigate and audit provider billing and UM auth request practices. Some of your key responsibilities will be researching providers, reviewing CMS alerts, as well as keeping up-to-date and managing compliance risks that impact our business and the DMEPOS industry. You will work closely with our Compliance Manager, Payer Division and partner with individuals at all levels of the company. If you are a self-starter, service-oriented, and able to interpret and communicate complex information, then this is an excellent opportunity as a next step in your career

JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES

The Compliance Analyst’s responsibilities include but are not limited to:

The primary focus of this role will be to conduct audits of vendors and healthcare providers in support of our FWA monitoring processes

Run the Fraud, Waste, and Abuse investigation processes

Support the administration of the company’s Corporate Compliance program

Assign and monitor compliance training and keep detailed, auditable records

Collaborate with our credentialing, quality assurance, and network management teams to address any concerns and implement change as needed

Partner with health plan customers on audits of our business, draft and track audit processes and responses

Investigate compliance concerns and issues internally and externally

Ensure we are up to date with licensing and other filings with state agencies

Conduct Security Risk Assessments and present results to the compliance committee.

Work closely with our data security staff to address security issues that arise

Reports to our Compliance Manager, Payer Division

Your first 30 days

Within the first month, you will learn about Integra’s business, our policies and procedures, learn how Medicare and Medicaid guidelines impact our business, how we run our compliance programs, and be introduced to the teams with which you will partner cross-functionally.

Your first 60 days

Within your first 90 days working with the company, you will initiate audits of providers in our network, research current FWA events and respond to plan questions.

Your first 6 months

We expect that within six months you will have a strong grasp of the rules and regulations which govern our business. You will take ownership of audits and partner with teams on assigned compliance or security concerns. We expect that you’ll also be able to recommend ways in which we can improve our processes, procedures, and making sure we’re up to date with regulatory changes impacting the business.

EDUCATION: Bachelor’s degree

EXPERIENCE:

At least three years’ experience in Special Investigation Unit processes or similar roles; previous healthcare experience is required, DMEPOS experience preferred.

Strong understanding of fraud waste and abuse issues, healthcare credentialing, medical billing, HIPAA, and related legislation

Experience with data analysis and excellent user of Excel. Experience with Tableau a plus.

Strong attention to detail and able to interpret and communicate complex information

Effective written and verbal communication skills

Working knowledge of medical billing processes

Excellent organizational skills, ability to manage multiple projects at once, follow through, and meet tight deadlines.

A commitment to provide high quality client service and a strong desire to build trusted advisor relationships with key clients and executives.

Ability to manage and handle sensitive and confidential information with the highest levels of integrity, ethical standards, discretion, and sound judgment.

Team player able to collaborate across various teams and levels and form strong working relationships

SALARY: $85,000.00/annually

Posting text as published by Integra Partners.

The evidence behind this listing

Workplace

Remote Employer field

Seniority

Not established

Employment type

full time

Location as listed

Troy, MI, United States

Pay and work authorization

Stated pay

Not stated

Visa sponsorship

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Security clearance

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Citizenship

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