Compliance Analyst III

Organization:

SHSO-Sutter Health System Office-Valley

Position Overview:

Assists the Compliance Officer or Ethics & Compliance leadership in coordinating, implementing, administering and evaluating the Sutter Health Ethics and Compliance Program at system-level or assigned entities to ensure compliance with applicable health care service plan laws, regulations, and standards (e.g., Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS) and the Office of the Inspector General (OIG)) and Sutter Health's policies and procedures. Collaborates with entity organizational staff, Ethics and Compliance staff, and Legal and Risk Services team members regarding changes in federal and state laws and regulations for health care service plans and the organization's policies and procedures. Plans, executes, and oversees a variety of complex regulatory compliance based projects. Assists with conducting internal investigations and compliance risk assessments, regulatory filings and reports, regulatory audits and inquiries and compliance policies and procedures. Serves as a resource person to support the various activities of the Ethics and Compliance Program and includes monitoring, data quality assurance, training and education, and managing any confidential reporting received via mailbox or phone messaging.

Job Description:

The person selected for this role must come on site for meetings, work, etc. and live in the Northern California Sutter Health footprint. This is NOT a remote role.

EDUCATION:
Equivalent experience will be accepted in lieu of the required degree or diploma.

Bachelor's: Business Administration or related field or equivalent education/experience


CERTIFICATION & LICENSURE:

CHC-Certified in Healthcare Compliance within 1 Year of hire


TYPICAL EXPERIENCE:

5 years recent relevant experience.

SKILLS AND KNOWLEDGE:

In-depth knowledge of effective healthcare ethics and compliance program, including requirements, management, monitoring, conducting and documenting investigations, addressing violations, tracking corrective actions, and training.

Knowledge of healthcare clinical operations, hospital revenue cycle systems, healthcare billing and coding requirements, or other healthcare compliance requirements/issues.

Knowledge of medical terminology, standard medical abbreviations, and the disease process as well as general legal terminology, principles, procedures, and available legal resources.

Familiar with healthcare industry, including current trends, cultural concerns, and local/state/federal regulations, such as the CA Knox-Keene Act, California Insurance Code, Office of Inspector General (OIG) Work Plan, Affordable Care Act (ACA), and HIPAA regulations, in addition to federal and state reimbursement program requirements (e.g., Medicare and Medi-Cal).

Attention to detail with time management and organization skills, including the demonstrated ability to strictly adhere to multiple timelines.

Understanding of business acumen and analytic skills with the proven ability to analyze data and information, reach practical conclusions, recommend corrective actions, resolve conflicts, and institute effective changes.

Excellent written/verbal communication, interpersonal, and presentation skills with the ability to understand legal and regulatory requirements, healthcare laws, or sensitive information clearly and diplomatically to diverse audiences.

Proficient computer skills, including competency in Microsoft Office Suite (Word, Excel, and PowerPoint), Visio, Project, Crystal Reporting, and other software.

Ability to
• manage and organize large amounts of data in an efficient and clear manner, specifically in a regulatory and compliance-filing function.
• identify potential concerns and compliance issues, and then assist in the development and implementation of actionable recommendations or process improvements to resolve the problem.
• advise management and other stakeholders regarding the impact of emerging industry trends in compliance enforcement, legislation and regulations.
• abstract information from medical records, reports, chart entries, related patient documentation, and interviews while conducting audits and investigations.
• work independently, as well as part of a multidisciplinary team, while efficiently and effectively conducting audits and investigations within established timeframes and government regulations.
• manage, prioritize, and drive multiple projects while navigating competing priorities to deliver quality products and services on-time and on-budget.
• make informed decisions based on the analysis of multiple sources of information while providing new perspectives on existing solutions.
• foster an open and collaborative environment that invites discussion about the compliance process and its value, influences individuals or groups with diverse opinions, builds consensus, and enlists cooperation without direct control/authority.
• maintain strict confidentiality of sensitive material (compliance and risk management data) and ensure the privacy of each patient’s protected health information (PHI).
• work effectively with staff, peers, senior management, physicians, state/federal agencies, and external organizations.
• build collaborative working relationships with peers, other departments, stakeholders, management, vendors, and government agencies to achieve compliancy.

Job Shift:

Days

Schedule:

Full Time

Shift Hours:

8

Days of the Week:

Monday - Friday

Weekend Requirements:

None

Benefits:

Yes

Unions:

No

This position is work from home eligible.

Position Status:

Exempt

Weekly Hours:

40

Employee Status:

Regular

Number of Openings:

1

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $48.72 to $73.08 / hour

The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.

Qualified applicants with arrest and conviction records will be considered for employment. Applicants for specific positions are still required to disclose certain convictions during the application process, and those convictions may also be considered in determining eligibility for employment in accordance with applicable law.

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