The Compliance Analyst position is responsible for supporting the compliance department in developing, implementing, and administering the continuity of the collective corporate compliance and accreditation programs. This role contributes to key compliance initiatives and organizational objectives. The Compliance Analyst is an essential part of the communication of regulatory and legal compliance within the Utilization Management industry. This role will work in collaboration with all members of the Compliance team, as well as all Nexus and ProPeer business leaders and staff, to develop, implement, and evaluate departmental goals, strategies, programs, and projects that support the continuous improvement process within the Utilization Management and Independent Review arena. Act as an integration and dissemination analyst to transfer knowledge and mobilize key tactics for improvement project activities. Contribute to the process of developing, executing, driving, and communicating the results of the organization's compliance program for improvement and key collaborative initiatives within budget and assigned deadlines.

Requirements

• Monitors developments and changes in federal, state, and local statutes, and regulations, to assess the impact on the organization and recommends implementation and compliance strategies.
• Tracks applicable licensing, laws, and regulations in the jurisdictions where the organization conducts business, and that might affect the organization's policies and procedures.
• Maintain and apply for business entity licensing with various Secretaries of State when required by law or regulation.
• Maintain current knowledge of accreditation, regulatory compliance, and licensure requirements.
• Prepares and submits state license applications for utilization review, independent review, and external review where applicable.
• Communicates effectively with various local, state, federal, and other regulatory bodies.
• Understands and is responsible for any regulatory or accreditation reporting requirements.
• Ability to understand, interpret and critically apply regulatory requirements to the organization's operations by preparing a gap analysis report that will highlight gaps and provide potential solutions.
• Creation, revision, and editing of Compliance policies and procedures under the direction of the Chief Legal Officer
• Perform and complete audits to meet client, regulatory, and accreditation requirements.
• Assists in the development, drafting, and maintenance of the company's collected policies, procedures, and best practices documentation.
• Oversee and lead specific projects and project teams as needed.
• Responsible for updating, facilitating, and tracking ongoing compliance training and education both internally and externally.
• Develops audit and monitoring tools for compliance-related activities.
• Provides logistic and operational support for key compliance entities and initiatives (e.g., Compliance Committee)
• Provide input for the compliance department's Work Plan and risk assessments.
• Monitoring and reporting of anonymous feedback regarding the organization's compliance processes
• Assists in the administration of the company's compliance & accreditation programs.
• Promotes adherence to the organization's compliance program.
• Provides support for ad hoc projects, assignments and other initiatives as needed.
• Experience in leading committees, activities, and staff.
• Other duties as assigned by the Chief Legal Officer

Knowledge and Abilities Requirements:

• Knowledge of utilization review processes and managed care
• Preferred experience with the elements of an effective compliance program, as well as accreditation bodies, such as URAC and NCQA
• Knowledge and experience using continuous improvement/ Lean methodologies and processes.
• Ability to work proactively under tight timelines and budgets.
• Ability to coordinate compliance activities involving several departments and processes simultaneously.
• Demonstrated ability to problem-solve complex, multifaceted situations.
• Ability to maintain a professional manner and function at all levels of management.
• Ability to conduct meetings, compliance training sessions, and other compliance-related activities.
• Ability to demonstrate strong communication, interpersonal, analytical, writing, presentation, self-motivation, broad thinking, and business skills.
• Strong organizational and task prioritization skills
• Strong analytical, numerical, and reasoning abilities
• Ability to establish credibility and be decisive - but able to recognize and support the organization's preferences and priorities.
• Project Management experience or ability; awareness of current and emerging trends in project management technologies, techniques, issues, and approaches
• Competence in both oral and written English
• Ability to establish and maintain effective and harmonious work relationships with team members, physician panel members, state regulators, clients, and vendors.
• Proficient in the use of Microsoft Windows, Word, Excel, and PowerPoint required.

Education and Experience:

• Preferred 3-5 years' experience in the healthcare compliance environment of an accredited organization.
• Previous auditing and/or entity accreditation experience preferred.
• Bachelor's Degree in health information management, health administration, business administration, public administration or related preferred

License and Certification: Willing to obtain various compliance-based certifications within the industry.

Position Demands:

This position requires sitting, bending, and stooping for up to 8 hours per day in an office setting. Ability to lift and move objects weighing up to 10 lbs. Ability to learn technical material. The person in this position occasionally needs to move about inside the office to access filing cabinets, office machinery, etc. Must be able to operate a computer and other office productivity machinery such as a calculator, copy machine, printer, etc. The person in this position frequently communicates with guests, team members, and vendors and must be able to exchange accurate information.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of our personnel. All team members may be required to perform duties outside of their normal responsibilities from time to time, as needed.