CareCentrix

  • Analyst - Compliance

    Job Locations US-FL-Tampa
    Job ID
    2018-6326
  • Overview

    CareCentrix is currently hiring for a Compliance Analyst job in Tampa, FL.  CareCentrix is making the home the center of patient care.  We improve patients' lives by delivering innovative home health solutions that produce better outcomes and reduce overall costs through partnerships with providers and payors.  CareCentrix is a growing organization and we are seeking dedicated individuals to be a part of this exciting and rewarding business.  We offer competitive pay and a full benefit package including health, dental, vision, 401K, and tuition reimbursement.

     

    The Compliance Analyst will lead the creation, validation, submission and overall management of all Revenue Cycle Management deliverables as part of any external or internal audit conducted by a CareCentrix client, regulator, external auditor or any other entity. Responsible for conducting routine audits and reviews of internal RCM policies and procedures to ensure compliance. Leads and executes the creation of corrective action plans (CAPs) for any deficiencies identified during any internal or external audit. Preparation and validation of monthly, quarterly and annual reports for our clients. Works under general supervision

    Responsibilities

    Compliance Analyst Job Responsibilities;

     

    • Review audit notifications to determine if any clarification is needed from the auditing entity. Interpret/Translate the specifications based on CareCentrix business practices and open tickets to request data universes based on the specifications. Validate data universes to ensure accuracy and make report(s) client ready.
    • Gather and package evidence as specified by the auditor(s). This includes but is not limited to requesting EOPs and copies of checks, making screen shots of claims screens and provider rates, etc.
    • Conduct internal audits on business practices related to claims to ensure compliance on areas such as prompt pay/LPI, acknowledgement letters, rejections, recoupments, etc. Maintain detailed records of audit activities and results. Prepare regular summary reports to management, along with specific and/or overall recommendations to correct any compliance issues.
    • Maintain detailed records of any issues or trends discovered while reviewing claims universes or selected samples. When necessary, open tickets to have issues researched and/or corrected or work with claims management to have claims adjusted.
    • Validation and preparation of monthly and quarterly reports. When necessary, participation in reviewing requirements to ensure data is being pulled correctly. Validate data universes to ensure accuracy and make report(s) client ready.
    • Identify process improvements for both production staff and the system. Participate in the development, testing and/or implementation of new procedures and/or IT system enhancements. Maintain a strong working relationship and open communication with staff from other departments including IT.
    • Maintains working knowledge of all CareCentrix business rules and any changes in existing business and systems related to claims payment and claims processing.
    • Develops strong positive relationships with both internal and external business partners, and researches complex claim processing problems to ensure prompt, effective and compliant resolution and communication.
    • Reviews and adheres to all Company policies and procedures and the Employee Handbook.
    • Participates in special projects and performs other duties as assigned.
    • Less than 10% travel required.

     

    Qualifications

    Compliance Analyst Job Qualifications;

     

    • Bachelor’s Degree in the areas of Accounting, Finance, Management Information Systems or similar field of study.
    • Five years of prior experience in compliance, quality assurance, and/or auditing role required.
    • Proficient in MS Office applications including Excel, Visio, PowerPoint and Word.
    • Prior experience and knowledge of health care and managed care are desired.
    • Excellent analytical, verbal and written communication skills are required.
    • Must be able to work in high pressure situations and meet tight deadlines.

     

    We at CareCentrix know that our work matters and that we make a difference. We take pride in what we do and truly believe that our most valuable assets are our employees

    CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.

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