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Compliance Analyst-MLTC

Village Care – New York, NY

Compliance Analyst
VillageCareMAX is seeking an enthusiastic professional for our Full Time Compliance Analyst role. This position facilitates the implementation of controls within the organization s operational areas. You will interface with individuals responsible for Compliance initiatives including Regulatory, the Medicare Division and Vendor management as well as overseeing and driving initiatives at the direction of the Director of Compliance. You will provide subject matter expertise and guidance for all matters relating to CMS, NYSDOH and DFS compliance requirements.
Playing a key role with implementation and the Compliance Plan, you will conduct audits and provides investigational review assistance for the plan s Medicare and MLTC lines of business. You will perform FDR claim audits to ensure they are processed in accordance with provider contracts, member benefits, plan authorization and regulatory requirements. You will be responsible for supporting the compliance-monitoring program including performance of HIPAA audits of various locations, claims billing and benefit configurations. You will work collaboratively with operational areas to assist with implementing controls to enhance the efficiency and effectiveness of the department s compliance auditing and monitoring oversight.
We would like to speak to those who have a Bachelor s degree in Business, Health Administration or a related field along with 2+ years experience in a Managed Care setting required, preferably with Compliance/Audit or Quality Assurance. Must demonstrate proficiency with Commercial or Medicare claims processing and regulatory requirements. Familiarity with ICD-10, CPT, HCPCs, DRG, Revenue Codes, and Medical Terminology. Experience with analyzing and reconciling data will be vital to this role.
As part of the VillageCare team, you ll enjoy a highly competitive compensation and benefits package, including 403(b) retirement plan and more. VillageCare is an organization that offers a wide range of at-home and community-based services, as well as managed long-term care options that seek to match each individual s needs to help them attain and maintain the greatest level of independent living possible. VillageCare is a Drug-free workplace. Equal Opportunity Employer.

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