Job Description

Healthcare Compliance Analyst/Auditor (Quality Assurance Analyst)

Remote with occasional onsite up to 25% in Albany, NY

Contract till December 2026

Key Responsibilities:

• Evaluate child/youth's records for compliance to applicable regulations.
• Clearly communicate evaluation requirements and follow up.
• Evaluate documentation against applicable State/Federal regulations.
• Collect data and documentation to support compliance findings.
• Utilize technology to convert hard copy documentation to electronic and submit via secure file transfer.
• Record, summarize, and communicate compliance findings for the Children's Transformation Program.
• Assist in determining trends in non-compliance.
• Make appropriate and timely recommendations to project management.
• Assist with the ongoing operationalization of project's processes and procedures.
• Assist with all internal and external reporting.
• Build and maintain relationships with stakeholders to provide a high level of customer service.
• Traveling to provider sites to perform case reviews.

Required Qualifications:

• A minimum of 2 years of A minimum of 2 years of experience as a Healthcare Compliance Analyst, Auditor, Care Manager, or Medicaid Provider, in a role responsible for conducting oversight, compliance audits or chart reviews, or ensuring quality of care.
• An equivalent combination of advanced education, training, and experience will be considered.
• Experience with Medicaid fee-for-service and/or Managed Care billing.
• Proficiency in MS Excel, MS Word, MS Outlook, MS Visio, MS PowerPoint and MS SharePoint.
• Strong analytical and problem-solving abilities; able to evaluate data and make sound, evidence-based decisions.

Preferred/Desired Qualifications:

• Extensive knowledge of, and experience with, Home and Community-Based Services (HCBS) Waiver programs, including the 1915(c) NYS Children's Waiver, either as a provider or compliance officer.
• Experience working with eMedNY, CANS-NY, UAS-NY, Medicaid Health Homes, Medicaid Managed Care Organizations (MMCOs), or other related programs/systems.
• Experience with NYS Medicaid billing, including the use of various Electronic Health Records (EHR) systems.
• Experience working with Office of Mental Health (OMH), Office for People with Developmental Disabilities (OPWDD), or Office of Children and Families (OCFS).
• Ability to manage time independently while meeting deadlines and adhering to high performance standards.
• Experience with compliance audits or chart reviews.
• Ability to work with and relate to staff and demonstrate active listening skills.
• Process oriented and results-driven work strategy.
• Ability to foster teamwork with all levels of management and staff.
• Ability to work well independently and within a team.
• Exceptional customer service relationship techniques, including superior verbal and written communication skills.
• Excellent accuracy and attention to detail.

If you have candidates who are effective communicators who enjoy working in complex and collaborative environments, utilizing their critical thinking and research skills to develop solutions for clients, providing support to customers, and have the required education, experience and skills, please submit them.

Job Tags

Similar Jobs