COMPLIANCE ANALYST- Full Time

Job Description

Responsibilities

COME AND JOIN THE RMC FAMILY!

We have been in the community since 5. Our mission is to provide comprehensive multi-specialty medical services in the greater Riverside region. Your passion, inspiration, and talents are invaluable to us and our mission to serve others. Our facility can provide a place for you to thrive and continue your professional development. Quality Healthcare is our passion, improving lives is our reward. We are working to change lives and transform the delivery of healthcare.
Riverside Medical Clinic is the best place to work, practice medicine, and receive care.

SUMMARY : The Compliance Analyst ensures compliance with the timeliness of decisions, initial notifications, and written notifications following the Centers for Medicare and Medicaid Services (CMS), the Department of Health Care Services (DHCS), the Department of Managed Health Care (DMHC), and other regulatory and accrediting bodies requirements and standards. The Analyst assists with Health Plan audits concerning the Utilization Management (UM) program and processes and ensures timely audit submissions for UM, Claims, Credentialing, and other delegated functions. Collaborates with, takes part in, or may lead cross-functional teams to ensure delegated activities follow regulatory and contractual obligations. Research, investigate, and identify actual and/or potential non-compliance with standards and escalate concerns to the Delegation Oversight Supervisor. Audit and review referrals to ensure compliance with regulatory requirements. Ensure staff complies with Language Assistance Program Requirements for LEP members.

QUALIFICATIONS : To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

Qualifications

EDUCATION and/or EXPERIENCE : High school diploma or general education degree (GED) and at least one (1) year related experience and/or training required. Prefer two (2) years of experience in health plan/UM operations, managed care/medical group operations, independent physician association (IPA) operations, MSO operations, or healthcare auditing. Familiarity with, or intermediate skills in Excel, data management, data validation, data analyses, and process mapping. One (1) year of experience in delegation oversight audits, monitoring, and tracking highly desired,

CERTIFICATES, LICENSES, AND REGISTRATIONS: None.

LANGUAGE SKILLS : Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.

MATHEMATICAL SKILLS: Ability to calculate amounts and figures such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.

WORK ENVIRONMENT: The noise level in the work environment is usually moderate.

BENEFIT HIGHLIGHT:
• Challenging and rewarding work environment.
• Competitive compensation and paid time off.
• Excellent Medical, Dental, Vision and Life Insurance Plans.
• (K) with company match and discounted stock plan.

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 care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.

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.

AVOID AND REPORT RECRUITMENT SCAMS

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 (e.g., Social Security Number, credit card or bank information, etc.) 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.