Medicare Compliance Analyst - Great Health Organization -100% remote
Company: Fallon Community Health Plan
Location: Worcester
Posted on: June 25, 2022
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Job Description:
Medicare Compliance Analyst - Great Health Organization -100%
remoteUS-MA-WorcesterJob ID: 6775Type: Full Time# of Openings:
1Category: Corporate ComplianceFallon Health - Corp HQOverviewAbout
Fallon HealthFounded in 1977, Fallon Health is a leading health
care services organization that supports the diverse and changing
needs of those we serve. In addition to offering innovative health
insurance solutions and a variety of Medicaid and Medicare
products, we excel in creating unique health care programs and
services that provide coordinated, integrated care for seniors and
individuals with complex health needs. Fallon has consistently
ranked among the nation's top health plans, and is accredited by
the National Committee for Quality Assurance for its HMO, Medicare
Advantage and Medicaid products. For more information, visit
www.fallonhealth.org. Summary:This position is to support our
Medicare compliance program effectiveness through data analysis to
identify risks, trends by using data visualization and dashboards
to portray information to department leadership, Compliance
Committee, and Audit & Compliance Committee of the Board.
Individuals with strong organizational, technical, data
visualization and reporting skills are encouraged to apply.
Paramount to this position is the current monthly Medicare
Dashboard; its data accuracy, presentation/optics, timeliness,
including all information provided by vendors, must be flawless.
This position is responsible for completing all departmental
reporting and project related tasks accurately and within all
required timeframes. The incumbent must have excellent
organizational skills, understand the importance of regulatory and
other reporting requirements, be professional at all times, be
flexible and have the ability to multi-task, and prioritize work
accordingly to ensure the accuracy and integrity of reports.
ResponsibilitiesPerform departmental reporting and analyze data for
trending, issue resolution, and opportunities for efficienciesUse
SQL and Access to run queries/reports and ensure integrity of the
data.Understand data sources and the data to complete the reports
and analyze the data with management.Execute departmental reports
at the required frequency with implemented quality check
workflows.Analyze and review data on a regular basis to ensure
compliance and consistency.Communicate data outliers to business
owners, leadership and Medicare Programs management.Complete simple
ad hoc reporting/queries for as needed and coordinated with
management staff.Special projects as assignedIdentify opportunities
to innovateMaintain and improve systems and processes to support
our Medicare compliance program and departmental activities,
especially concerning the monthly Medicare DashboardUnderstand,
use, and translate data, including mastery of all required Program
Audit universes Analyze department and program information/data to
identify trends and risks; report identifying risks and trends back
to the business for action Convert complex subject matter to
accessible information for all colleaguesSupport and execute
program activitiesLeverage technology to support assigned program
activitiesMaintain documentation of program activitiesMaintain time
sensitive processes and meet organizational deadlinesPerform data
analysis and validation to ensure required accuracy and
specificationsEngage with internal business areas and vendors as
needed to address issues identified to ensure compliance with audit
protocolsUnderstand and communicate about what we do and whyDevelop
working understanding of organizational structure to enhance our
Medicare compliance programCollaborate with colleagues with the
ability to work across departments with a collaborative,
responsive, respectful approachCommunicate effectively with
internal and external partnersBe self-motivated, take initiative
and engage in critical thinking while being task-oriented, with
excellent follow through, patience and persistencePossess excellent
analytical and creative problem-solving abilities, a strong
commitment to accuracy and attention to detailAptitude to work in a
fast-paced environment, adapt to changing conditions, and meet
deadlinesQualificationsBachelor's degree in business, health care
or related area or equivalent job experience2-4 years of experience
working in a healthcare or other highly regulated environment; or
other relevant specialized experience, training or education2 years
Medicare Advantage experience preferred PACE requirements knowledge
a plusCompetent in SQL, Access, Word, Excel & PowerPoint. Ability
to execute queries. Proficient competences with data analytics,
data accuracy, QC & data integrity. Excellent interpersonal, verbal
and written communications skills.Fluency in Microsoft Office.
Strong ability to develop and implement tracking tools for
regulatory memos including dashboard, graphs, flow charts and other
visual aids. Possess excellent communication skills with the
ability to write clearly and concisely and interact with a wide
range of professional levels. Time management and organizational
skills are an extremely important aspect to this position due to
the strict deadlines imposed by government agencies. Strong
attention to detail a must.JT18PI179815366
Keywords: Fallon Community Health Plan, Worcester , Medicare Compliance Analyst - Great Health Organization -100% remote, Healthcare , Worcester, Massachusetts
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