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ArchWell Health · 2 days ago

Analyst, Compliance, Privacy & Risk Management

Nashville, TN

Full-time

Onsite

Senior Level

5+ years exp

ArchWell Health is focused on providing excellent care for seniors. The Audit Analyst for Compliance, Privacy & Risk Management is responsible for overseeing auditing processes, conducting compliance risk assessments, and ensuring adherence to regulations and company policies.

Health Care

Responsibilities

Adheres to assigned audit schedule and reviews as outlined in the Compliance Workplan

Assists with reviewing internal and external inquiries regarding compliance and privacy matters, including government and third-party payor requests

Conducts audits and focused reviews to ensure compliance with company, government, and payor guidelines

Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc

Assists with maintaining regular and consistent governance-level reporting and metrics for the Compliance department, including but not limited to dashboards, board reporting, weekly, monthly, and annual compliance & ethics reporting

Maintain a working knowledge of HIPAA, HHS, and CMS regulations

Participate in the planning and scheduling of compliance projects

Research compliance related questions upon request from departments and/or practices

Identify and report potential audit and compliance risks

Qualification

Compliance auditingHIPAA knowledgeMedicareMedicaid rulesHealthcare Compliance certificationAnalytical skillsMS Office proficiencySelf-directedVerbal communicationWritten communicationInterpersonal skillsOrganizational skillsProblem-solving skills

Required

Knowledge of Medicare and Medicaid documentation and coding rules and guidelines

Must have an understanding and knowledge of national and state laws and regulations

Must have excellent verbal and written communication skills

Strong interpersonal skills

Strong organizational and planning skills

Demonstrates a high degree of personal integrity and practice ethical standards

Demonstrates proactiveness and ability to work independently and self-directed in managing multiple concurrent projects

Excellent analytical and problem-solving skills

Advanced skills in all MS Office applications (Word, Excel, Outlook, and PowerPoint)

Ability to interpret and apply documentation and coding rules and regulations

Ability to demonstrate competence in performing audits, produce reports, formulate remediation or mitigation plans, and conduct follow-up audits

Equivalent of 5+ years' experience in compliance auditing, clinical chart reviews, medical necessity review/auditing, revenue integrity, and/or health care compliance

Experience in compliance and privacy auditing techniques and methods