Lorven Technologies
Senior Analyst
Lorven Technologies, Denver, Colorado, United States, 80285
The job responsibilities of the Senior Analyst, Compliance (Clinical Documentation and Billing Investigations) include, but are not limited to the following, with a goal of mitigating risk related to the False Claims Act and other state and federal regulations:
Investigate potential compliance issues linked to clinical and billing activities, including clinical IT systems;Conduct IT system investigations and audits including performing risk assessments, scoping investigations/audits, developing investigation/audit work plans, performing investigation/audit procedures, documenting work, reporting findings, and developing and implementing appropriate remediation;Perform proactive process and control assessments of policies, procedures and clinical IT systems;Define and understand potential compliance issues, collect and analyze large amounts of data, perform research, identify root causes of potential issues, and evaluate risk to make timely and appropriate decisions;Utilize Excel, Access, and other tools to perform qualitative and quantitative analyses on large amounts of clinical and billing data and develop presentations to communicate the results of such analyses to compliance and operations management;Conduct multiple projects concurrently while managing timelines with their manager and internal customers and assist their manager with projects related to the overall compliance audit and monitoring programs;Draft written presentations to compliance and operations management to inform decision making; andNo direct reports.Qualifications
Bachelor's degree required; JD/CPA/CIA/MBA or other relevant advanced degree or certification a plus;Certificate in Healthcare Compliance preferred;Minimum of 3 years' experience as an investigative, audit, compliance, or legal professional responsible for compliance investigations, external/internal audits, and consulting projects (e.g., process and control assessments);Preferred experience working with Medicare Fee for Service claims and respective electronic health record and billing IT systems;Preferred experience working for Big 4 or mid-sized audit firms, other consulting firms, or a healthcare company;Preferred experience in healthcare industry dealing with federal healthcare program laws, specifically the False Claims Act;Preferred experience working with Medicare Fee for Service regulations including CMS Conditions for Coverage (CfC), Conditions for Participation (CfP), and other CMS Manuals;Strong organizational and project management skills with demonstrated attention to detail;Experience in positively and successfully managing relationships with a high energy and diverse group of internal customers across organizational lines;Advanced technology skills including Excel, PowerPoint, and Access including experience with using these tools to create data analytics (e.g., Pivot Table, Vlookup, etc.);A thoughtful, articulate and effective critical thinker and communicator who can distill and articulate the important aspects of any issue;Superior written and verbal communication skills (including presentations) and the ability to drive execution in a team environment;Must be self-motivated, team player with proven ability to identify issues, manage priorities, and deliver on commitments in a fast paced environment; andHands on, efficient and proven ability to "Get Stuff Done" with a bias for action and a strong sense of ownership.Limited travel required: up to 10%
Investigate potential compliance issues linked to clinical and billing activities, including clinical IT systems;Conduct IT system investigations and audits including performing risk assessments, scoping investigations/audits, developing investigation/audit work plans, performing investigation/audit procedures, documenting work, reporting findings, and developing and implementing appropriate remediation;Perform proactive process and control assessments of policies, procedures and clinical IT systems;Define and understand potential compliance issues, collect and analyze large amounts of data, perform research, identify root causes of potential issues, and evaluate risk to make timely and appropriate decisions;Utilize Excel, Access, and other tools to perform qualitative and quantitative analyses on large amounts of clinical and billing data and develop presentations to communicate the results of such analyses to compliance and operations management;Conduct multiple projects concurrently while managing timelines with their manager and internal customers and assist their manager with projects related to the overall compliance audit and monitoring programs;Draft written presentations to compliance and operations management to inform decision making; andNo direct reports.Qualifications
Bachelor's degree required; JD/CPA/CIA/MBA or other relevant advanced degree or certification a plus;Certificate in Healthcare Compliance preferred;Minimum of 3 years' experience as an investigative, audit, compliance, or legal professional responsible for compliance investigations, external/internal audits, and consulting projects (e.g., process and control assessments);Preferred experience working with Medicare Fee for Service claims and respective electronic health record and billing IT systems;Preferred experience working for Big 4 or mid-sized audit firms, other consulting firms, or a healthcare company;Preferred experience in healthcare industry dealing with federal healthcare program laws, specifically the False Claims Act;Preferred experience working with Medicare Fee for Service regulations including CMS Conditions for Coverage (CfC), Conditions for Participation (CfP), and other CMS Manuals;Strong organizational and project management skills with demonstrated attention to detail;Experience in positively and successfully managing relationships with a high energy and diverse group of internal customers across organizational lines;Advanced technology skills including Excel, PowerPoint, and Access including experience with using these tools to create data analytics (e.g., Pivot Table, Vlookup, etc.);A thoughtful, articulate and effective critical thinker and communicator who can distill and articulate the important aspects of any issue;Superior written and verbal communication skills (including presentations) and the ability to drive execution in a team environment;Must be self-motivated, team player with proven ability to identify issues, manage priorities, and deliver on commitments in a fast paced environment; andHands on, efficient and proven ability to "Get Stuff Done" with a bias for action and a strong sense of ownership.Limited travel required: up to 10%