Healthcare compliance [h1.location_city]

Responsibilities

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Learn more at :

Job Summary : The Compliance Analyst provides support to the organization to execute key initiatives for the effectiveness of the Compliance Program for health plan products, including Medicare Parts C and D, large- and small-group health plans, third-party administration, and other commercial health plan products. 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 be responsible for monitoring the organization’s compliance with state and federal regulations. The Analysts will perform internal audits for the organization, manage regulatory communication, and facilitate engagement with external and internal stakeholders. The Compliance Analyst will support the Compliance Program to ensure compliance with Federal and State laws and regulations contract provisions, accreditation standards, and internal policies and procedures. This position reports to the Manager of Compliance & Risk.

Job Duties :

• Ensures Completion of Compliance Training by Prominence Health Plan Employees
• Ensures Completion of Compliance Training by Agents / Brokers
• Manages and Distributes HPMS and Agency Communications
• Authors Operational Audit Reports
• Authors and Facilitates Implementation of Operational Corrective Action Plans
• Performs Operational Audits
• Maintains Masterfile of Operational Risk Areas
• Performs / Facilitates External Compliance Audits
• Performs / Facilitates External Financial Audits (1 / 3 Financial, Bid Audit, Program Audit,
• Performs / Facilitates OIG / GSA Exclusion Screening (Prominence Health Plan Staff-FT / PT, Volunteers, Interns, Board Members, Providers)
• Operational Incident Management Resolution
• Performs / Facilitates Operational Corrective Action Plan Resolution and Monitoring
• Performs Operational Risk Assessment
• Performs Compliance Program Effectiveness Risk Assessment
• Coordinates Compliance and Department Meetings

Benefit Highlights :

About Universal Health Services :

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory car

Qualifications

Qualifications and Requirements :

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

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At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS

and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (., Social Security Number, credit card or bank information, from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.