Compliance Analyst, Claims - FT/Days at MEMORIAL HEALTH SERVICES in Fountain Valley, California

Job Description:

Position Summary

Develop & maintain templates, forms, tools and reports to monitor the organization's performance as it measures to health plan, CMS, and DMHC compliance standards. Responsibilities include the creation and submission of monthly and quarterly regulatory reports, including MTR, ODAG, PDR, and health plan audit preparation.

Collaborate with IT on ever-changing reporting requirements per health plan and ensure changes are implemented within required timeframes. Participate in the continuous quality improvement processes. Maintain a working knowledge of department standard operating procedures.

Essential Duties

• Develop, maintain, and update Compliance & Audit reporting and universe templates and databases. Knowledge of query reports, and/or how to write reports for special data request.
• Understanding the technical specification from requestor. (Health Plan, CMS, DMHC).
• Knowing what questions to ask from the requestor for the correct data to be run.
• Collect, analyze and summarize information to prepare informative reports.
• Generate Claims universes for health plan, CMS, DMHC audits.
• Generate monthly and quarterly reporting for health plans for all business segments and lines of business.
• Generate daily/weekly, or monthly or on demand reporting as requested by Management and other duties as assigned.

• Minimum 2 years work experience in data analysis and reporting.
• Project management experience and/or experience in managing deadline-driven tasks.
• Strong proficiency in computer application skills including Microsoft Office Suite (Word, Excel, Outlook, Visio).
• Prior claims processing and PDR/Reopen experience or comparable business experience

• Bachelor's degree in Business, HealthCare Administration, Computer Science or related field.