Overview:
Job Overview
The Compliance Analyst leverages exceptional communication, robust problem-solving, and decisive decision-making skills to effectively project manage critical operational activities. This role focuses on ensuring that the Gaudenzia community understands and adheres to the organization’s compliance policies, procedures, and relevant federal, state, and local regulations.
Additionally, the Compliance Analyst oversees the creation of comprehensive quality reports, analyzes data, manages complaints, and coordinates follow-up in investigations to uphold organizational standards and regulatory compliance.
Responsibilities:
Duties and Responsibilities
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Internal Complaint/Grievance Process Management: Serve as the primary point of contact for receiving complaints and grievances via Gaudenzia's internal system (e.g., GLine). Summarize and document concerns/issues presented by internal and external stakeholders. Collaborate with Program Leadership and Human Resources to facilitate resolution and document outcomes accordingly.
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Quarterly Analysis and Reporting: Conduct quarterly analysis of all complaints and grievances received by the Compliance Department. Prepare comprehensive reports highlighting trends, issues, and resolutions.
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Credential Review: Conduct reviews of credentials for all licensed employees and contract staff. Notify Program Leadership and Human Resources promptly of any negative findings and ensure appropriate follow-up.
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Medical Record Requests: Conduct an initial review of requests and collaborate with Senior Compliance Specialist/Records Custodian to process “standard” requests (e.g. Social Security or from regulatory funders).
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OIG Exclusion Checks: Establish audit controls to ensure compliance with OIG Exclusion Checks for vendors/entities. Ensure all service providers are properly screened and vetted according to regulatory requirements.
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Medicaid Services Compliance: Collaborate with Human Resources to review exclusion lists and ensure compliance of employees and medical professionals providing Medicaid services.
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Compliance Violations and Incidents: Quarterly analysis of all compliance-related reportable violations, critical incidents, and adverse events. Track and monitor investigation correction action plans in collaboration with Program Leadership.
Skills, Knowledge, and Abilities
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Excel Knowledge: Proficiency in Excel, including advanced functions and formulas, to manage and analyze large datasets effectively.
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Analytical and Organizational Skills: Ability to analyze complex information, organize data efficiently, and derive meaningful insights.
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Data Visualization: Skill in simplifying and codifying large volumes of data into clear, focused visualizations such as graphs, pivot tables, and dashboards.
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Report Preparation: Capable of preparing detailed, accurate reports that include visual elements to enhance understanding and decision-making.
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Independent Work Ethic: Ability to work autonomously, prioritize tasks effectively, and consistently meet deadlines across multiple concurrent projects.
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Regulatory Compliance Expertise: Extensive experience in coordinating regulatory compliance activities with a deep understanding of industry standards and best practices.
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Attention to Detail: Strong attention to detail and accuracy, even under pressure, ensuring compliance with agency policies and procedures.
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Confidentiality: Discretion in handling confidential information according to agency policies and legal requirements.
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Communication Skills: Effective verbal and written communication abilities to articulate complex ideas clearly and professionally.
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Interpersonal Skills: Collaborative team player with the capacity to accept feedback and contribute effectively to team objectives.
Qualifications:
Minimum Requirements
Education/ Training:
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Bachelor’s degree in a relevant field (e.g., Business Administration, Healthcare Administration, Compliance) preferred.
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Proven experience in compliance, audit, or related roles within healthcare or social services.
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Strong understanding of regulatory requirements, compliance frameworks, and project management.
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Demonstrated hands on experience with Microsoft functionalities such as Excel, Word, SharePoint, Outlook.
- Experience with compliance software tools and database management
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Familiarity with healthcare regulations.
Experience:
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Minimum of 1-2 years of experience.