Our Mission: Provide the best value in health insurance and related health services to improve the quality of life for Arizonans.
Inspire health in Arizona as the trusted leader in delivering affordable, innovative healthcare solutions.
Our Benefits: Our benefits provide work-life balance and the flexibility you need to be your best. We offer comprehensive medical, dental, and vision coverage; a 401K savings plan; paid holidays and vacations; and much more!
The Compliance Analyst - Vendor Oversight (CA-VO) Analyst supports the administration of the Compliance Program across all lines of business, including but not limited to the Medicaid and Medicare Advantage products.
- The CA-VO coordinates with the designated business leads to monitor, confirm and document subcontractor performance (a.k.a. delegated entities).
- The position also conducts auditing and monitoring activities in connection with subcontractor oversight and the ongoing risk assessment component of the compliance program which identifies areas of focus based operational performance and evolving legal, contractual and regulatory requirements.
- Monitor, confirm and document subcontractor performance through completion of these activities:
- Pre-delegation audits;
- Regularly occurring joint operating committees (JOC);
- Routine and recurring subcontractor performance reports;
- Periodic reviews and annual audits;
- Documented corrective action plans
- Maintain and track whether the subcontractors submit timely and accurate deliverables required by State and federal regulations including both routine/recurring reports and ad hoc requests.
- Maintain tracking and filing system for all communications with subcontractors
- Partner with business owners to review and escalate issues or concerns associated with subcontractor performance and areas suspected and confirmed non-compliance
- Hold quarterly subcontractor oversight meetings with designated business leads to report on oversight activities and identified non-compliance.
- Provide support to Compliance program auditing and monitoring activities, including internal privacy reviews.
- Participation in internal and external meetings.
- Support reviews of legal, contractual and regulatory guidelines in response to inquiries.
- The Position is (i) knowledgeable about the legal, contractual and regulatory requirements that apply to the areas subject to auditing and monitoring activities as conducted under the compliance program, (ii) independent and (iii) not engaged in self-policing. This position has access to relevant personnel, information, records and areas of operation under review, including information pertaining to any external entities that perform functions on behalf of Health Choice, at all levels necessary to satisfactorily conduct and report on auditing and monitoring activities.
- Vendor contract management and reporting
Education / Experience / Other Requirements
- This position requires a Bachelor’s degree in healthcare, social or behavioral science, or analytics; preferably in a writing-intensive discipline.
Years of Experience:
- Managed Care Compliance experience required: 1-3 Years
- Internal and external Auditing required: 1-3 years
- General knowledge of Medicaid and Medicare
- General knowledge of health care operations necessary
- Knowledge of HIPAA privacy regulation and rules helpful
- Or, an equivalent combination of education and experience sufficient to successfully perform the essential duties of this position : 1-3 Years
- High degree of attention to detail and ability to work under pressure in conflict situations and under strict deadlines;
- Requires the ability to write narratively, in detail and at length in a clear and style regarding matters of high complexity and which require high degrees of accuracy and completeness, including reports of investigative activity about which one may be questioned later;
- Ability to interact with different groups of people at various levels and to provide assistance on a timely basis;
- Proficiency in Word, Excel, MS Outlook, database search tools, and use of Internet to research information.
- Familiarity with NCQQ, HEDIS, and CMS Core Measure requirements is desirable
*Position Located in Arizona*