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Memorial Hermann Health System

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Health Solutions

Compliance Monitoring Analyst

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Location 929 Gessner Road,Houston,TX 77024 Facility Memorial Hermann Tower Category Health Solutions Type Full time Requisition 100083617

At Memorial Hermann, we’re about creating exceptional experiences for both our patients and our employees. Our goal is to provide opportunities for our diverse employee population that develop and grow careers in a team-oriented environment focused on patient care.

Every employee, at every level, begins their journey at Memorial Hermann learning about the history of the organization and its established culture built on trust and integrity. Our employees drive this culture, and we want you to be a part of it.

Job Summary

Job Description Summary
The Compliance Monitoring Analyst is responsible for compliance oversight , auditing and monitoring processes in accordance with all applicable Federal and State laws and regulatory requirements, including CMS and TDI guidelines governing the administration and marketing of Medicare Advantage and Commercial plans.

Typically reports to Manager, Audit and Compliance.

Job Description

Minimum Qualifications:

Education: Bachelor’s Degree required.

Experience: Three (3) or more years in Medicare Advantage or Part D plan operations, prior compliance monitoring experience within a Medicare or other insurance health plan, drug plan, or PBM a plus.

Experience planning and drafting monitoring study designs, implementing monitoring studies, correlating and presenting findings.

Experience identifying and overcoming barriers to completion of a monitoring study, and to work through issues that may arise.

Possess competency and experience in the areas of risk management, business and operational processes, internal auditing, and other internal controls, and regulatory compliance.

Knowledgeable and compliant with all relevant laws, rules regulations and accreditation standards and requirement.

Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas.

Organizational skills with the ability to handle multiple tasks and/or projects at one time.

Customer service skills with the ability to interact professionally and effectively with delegates, internal business partners and staff from all departments within and outside the company.

Decision-making skills with the ability to investigate and weigh alternatives and select the course of action that provides the greatest benefit to the organization.

Problem solving skills with the ability to look for root causes and implementable, workable solutions.

Interpersonal skills with the ability to work in a fast-paced environment and participate as an independent contributor with little supervision or as an active team member depending on the situation and needs.

Proficient with Microsoft Applications: Word, Excel, PowerPoint, Access and Outlook; ability to navigate a Windows based environment.

Ability to travel.

Demonstrates commitment to the Partners-in-Caring process by integrating our culture in all internal and external customer interactions; delivers on our brand promise of “we advance health” through innovation, accountability, empowerment, collaboration, compassion and results while ensuring one Memorial Hermann.

Principle Accountabilities:

Conducts oversight activities, monitors root cause analysis for noted deficiencies, conducts oversight activities preparation of reports indicating the results of monitoring efforts. enforces and manages remediation plans when deficiencies are identified.

Conducts ongoing monitoring and promote the compliance of Medicare Advantage (Part C) and Prescription Drug (Part D) plan delegated operations in meeting the requirements established by Federal agencies, primarily the regulations and program guidance set forth by the Centers for Medicare and Medicaid Services (CMS).

Routinely monitor various functions within Delegate’s activities validating adherence to remediation plans where deficiencies are found and promoting adherence to new and/or updated regulatory requirements. Additionally, Analyst will be responsible for monitoring any reporting provided by delegate to validate adherence to contractual and CMS obligations.

Assists delegated entities in maintaining compliance by making recommendations, based on monitoring results, for improvement and facilitating training or work groups as needed. Conducts periodic monitoring and auditing activities to identify and assess areas of compliance risk and recommend opportunities for improvement.

Maintain monitoring tools by creating standardized forms using information identified by regulatory agencies’ monitoring elements and departmental policies and procedures. Increase awareness of monitoring protocols through accurate & timely reporting.

Assumes responsibility for promoting to the Parts C and D operational departments and providers the highest level of regulatory compliance and service delivery for members.

Supports implementation and maintenance of the Corporate Compliance Program.

Communicate, collaborate and cooperate with internal and external stakeholders.

Adhere to all Compliance/Program Integrity requirements.

Comply with HIPAA Regulations

Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.

Other duties as assigned.

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