RenoRecruiter Since 2001
the smart solution for Reno jobs

Compliance Analyst

Company: Renown Health
Location: Reno
Posted on: March 28, 2020

Job Description:

Position Purpose: The Compliance Analyst provides support to the organization in evaluating the effectiveness of the Hometown Health Compliance Program and governance processes for Medicare Advantage, Medicare Parts C and D and commercial benefit plans. The Compliance Analyst captures and analyzes data used to detect trends that may indicate systemic risks to the organization requiring further review, assessment, root cause analysis, or follow-up. The Compliance Analyst will support the Compliance Program to ensure compliance with all Federal and State laws and regulations (CMS, Nevada DOI, URAC), contract provisions, accreditation standards, and internal policies/procedures. The Analyst will implement system wide initiatives, policies and processes related to the Compliance Program and be responsible for program oversight, risk assessment, reports creation, communication strategy, education/training and auditing/monitoring. This position will serve as a resource to support the Compliance team in the general development of the Compliance Program including, but not limited to, developing the Compliance Work Plan, Fraud, Waste and Abuse Plan, Communication Strategic Plan, Audit Work Plan, Compliance Committee/Board reports, Compliance policies/procedures and standard work. -- Nature--and--Scope: This position is responsible for performing compliance audits and operational monitoring; special projects, as requested; and internal control and information systems evaluations at the direction of Senior Leadership and the Hometown Health Compliance personnel. This position must be objective and independent of the activity being reviewed. It is authorized to have free and unrestricted access to organization functions, records, property, and personnel. -- The incumbent will be challenged by the following: General knowledge of Health Insurance, Managed Care, Benefit Design, Nevada Revised Statutes (NRS), Nevada Administrative Codes (NAC), Medicare Advantage Prescription Drug plans (MA-PD) and Federal Regulations. The ability to apply knowledge to recognize the existence of problems or potential problems and identify additional research to be undertaken or assistance to be obtained in the following areas: internal audit standards, procedures and techniques, clinical principles and techniques, management principles and deviations from ethical business practices, and fundamentals of business subjects. Knowledge of Medicare programs and CMS regulations and the ability to provide operational guidance and support for defining and documenting data validation policies and procedures, requirements for technical specifications, and data reporting skills to support specified components of Medicare Part C & Part D programs. Knowledge of Vendor Oversight Program to include analyzing risk assessments, performing audits, creating reports, educating and following up with the business area to ensure processes exist to demonstrate compliance with delegation and vendor oversight requirements for the Plan. Simultaneous action at varying stages--initiation, follow through, and completion--on a number of different projects Resourceful, detail-oriented, and able to assimilate and analyze a wide variety of information, often working under deadline pressure with a variety of levels of staff Coordinate projects conducted by contracted external vendor and answer questions regarding the compliance review process. Review data and reports drafted by external vendor. Prepare clear, concise written reports related to the review findings for internal and external reporting purposes. Ability to review and understand insurance benefits for all product lines. Demonstrate the ability to design and develop reports, documents and spreadsheets. The ability to communicate verbally and in writing in a way that effectively conveys project background, objectives, activities, evaluations, conclusions, and recommendations. Decisive and exercises good judgment under pressure. Excellent organization, problem solving and analytical skills. Ability to review, analyze and interpret regulatory requirements in a clear and concise manner. Strict adherence of rules and regulations for confidentiality and compliance. Ability to maintain effective collaborative working relationships with internal staff. Ability to work independently with minimal supervision. -- This position does not provide patient care. The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job. Minimum--Qualifications:----Requirements-----Required--and/or--Preferred Education:--Must have working-level knowledge of the English language, including reading, writing and speaking English. Four-year degree from an accredited college preferred. Experience:--Minimum two years experience in compliance within the health insurance industry or health care, preferred. Experience with Medicare Advantage plans or Medicare Managed Care preferred. Computer--/--Typing:--Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.-- Typing 35 WPM.

Keywords: Renown Health, Reno , Compliance Analyst, Professions , Reno, Nevada

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Professions Jobs


CDL-A Household Goods Truck Driver
Description: CDL-A OTR Regional Company Driver Truck Driver JobsDrive How You Want.Drive Where You Want. Whether it s regional or OTR truck driver job opportunities that you re on the hunt for, United has a number (more...)
Company: United Van Lines
Location: Reno
Posted on: 04/1/2020

Flatbed Regional CDL Drivers - Earn up to $2,000/Week!
Description: Call 844 821-7222 today Earn up to 2000 per week Home EVERY WEEKEND - Regional Routes NO Local Founded in 2003, FST Services, Inc. is an asset based and third-party logistics provider. We provide (more...)
Company: Fuentes and Sons
Location: Sparks
Posted on: 04/1/2020

Electrical Drafter
Description: Drafter, Electrical - Reno br MSA Engineering Consultants MSA www.msa-ec.com is seeking a qualified MEP Electrical Drafter to support Electrical Designers and Engineers. A Drafter is an entry-level (more...)
Company: MSA Engineering Consultants
Location: Reno
Posted on: 04/1/2020


88M Truck Driver
Description: As a Truck Driver in the Army National Guard, you are the backbone of military support. By transporting cargo and supplies, you'll play an integral role in keeping the Guard moving forward. In this role, (more...)
Company: Army National Guard
Location: Reno
Posted on: 04/1/2020

Flatbed Regional CDL Drivers - Earn up to $2,000/Week!
Description: Call 844 821-7222 today Earn up to 2000 per week Home EVERY WEEKEND - Regional Routes NO Local Founded in 2003, FST Services, Inc. is an asset based and third-party logistics provider. We provide (more...)
Company: Fuentes and Sons
Location: Roseville
Posted on: 04/2/2020

Shopper & Driver - Supermarket (Car Required)
Description: FULL-SERVICE SHOPPERWhy shop and deliver with Instacart Instacart is the North American leader in grocery delivery. We strive to help make grocery delivery effortless, affordable, and accessible to everyone. (more...)
Company: Instacart
Location: Reno
Posted on: 04/1/2020

Project Controls Analyst / Business Analyst
Description: Job Title:--Project Controls Analyst / Business AnalystSector:--Substation Capital Projects for Electric Utility CompanyLocation: Rocklin, CA Ideal candidates will have project management experience (more...)
Company: TD Thornton
Location: Rocklin
Posted on: 04/1/2020

Supervisor Production I
Description: IGT is the global leader in gaming. We enable players to experience their favorite games across all channels and regulated segments, from Gaming Machines to Lotteries to Interactive. We have a well-established (more...)
Company: IGT
Location: Reno
Posted on: 04/1/2020

Electrical Design Engineer
Description: Minimum Required Skills Electrical Design, AutoCAD, Electrical Engineer, Mechanical Engineering, Commercial, Retail Projects, warehouse projects, Lighting, Power, Revit If you are a Electrical Design (more...)
Company: CyberCoders
Location: Roseville
Posted on: 04/1/2020

CDL-A Truck Driver - Walmart Transportation
Description: LOCATION McClellan Park, CACAREER AREA Drivers TransportationJOB FUNCTION DriverEMPLOYMENT TYPE Full TimePOSITION TYPE -REQUISITION 1400069BRWhat you'll doWALMART TRANSPORTATION is Hiring CDL-A Drivers (more...)
Company: Walmart
Location: Rocklin
Posted on: 04/1/2020

Log In or Create An Account

Get the latest Nevada jobs by following @recnetNV on Twitter!

Reno RSS job feeds