Anthem QI/Compliance Analyst Sr - PS 8133 (Chicago, IL location - not remote) in Olympia, Washington

QI/Compliance Analyst Sr - PS 8133 (Chicago, IL location - not remote)

Location: Chicago, Illinois, United States

Field: Fraud

Requisition #: PS8133

Post Date: Aug 09, 2018

Your Talent. Our Vision. At AIM Specialty Health (AIM), a proud member of the Anthem, Inc. family of companies, it’s a powerful combination, and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve.

*This position is located in Chicago, Illinois

The QI/Compliance Analyst Sr is responsible for supporting a business unit by the implementation, active management and administration of state and federal compliance program, with specific focus on regulatory impact assessments, mandate and legislation implementation oversight and regulatory relationship management and litigation assessment and implementation.

Primary duties may include, but are not limited to:

  • Participates in Quality Management (QM) activities that ensure program meets regulatory standards.

  • Prepares department for oversight audits and ensures that regulatory developments are communicated timely where appropriate and with all applicable parties.

  • Maintains oversight of corrective action plans in response to areas of non-compliance.

  • Develops and ensures compliance program meets its stated objectives; provides subject matter expertise in response to day to day business issues; researches applicable subject matter practices and remains aware of industry trends; manages. relationships and partners with corporate and regional business areas and coordinates training related to compliance program.

  • Coordinates flow of information and documentation between associates responsible for day-to-day activities related to accreditation or regulatory reviews.

  • Develops and implements accreditation/ regulatory review tracking system.

  • Maintains accreditation and/or regulatory review compliance library.

  • Creates audit tools, reports, standardized policies and procedures, and provider manuals.

  • Facilitates implementation of survey or regulatory recommendations.

  • Assess and evaluate progress towards meeting regulatory standards.

  • Recommends new process if necessary.

  • Trains associates on new and revised standards.

  • Compiles documentation for presentation to accrediting/regulatory organization.

An Equal Opportunity Employer/Disability/Veteran

Requires a BA/BS in business or a related field; 5 - 7 years’ experience in a healthcare setting with 3 years quality management process experience, experience preparing for regulatory audits and knowledge of regulatory standards; or any combination of education and experience, which would provide an equivalent back ground.

Our pioneering spirit and dedication to improve health care continues to produce significant industry-first advancements, quality recognition achievements, and high satisfaction rates. AIM is certified by the National Committee for Quality Assurance (NCQA) and has received Full Accreditation for Health Utilization Management from the Utilization Review Accreditation Commission (URAC.)

Please note, this position must be located in our Chicago, IL location and is not a remote position.

To learn more, visit www.aimspecialtyhealth.com at http://www.aimspecialtyhealth.com/ .

About AIM Specialty Health

AIM Specialty Health (AIM) is a leading specialty benefit management company that promotes appropriate, safe and affordable healthcare services. We are a member of the Anthem family of companies, which is recognized as one of the nation’s leading health benefits companies.

AIM provides innovative clinical solutions that focus on today’s most complex and costly tests and treatments in radiology, cardiology, medical and radiation oncology, specialty drugs, sleep medicine, musculoskeletal and pain management, genetic testing, palliative care, and other emerging clinical areas.

With evidence-based medicine, technology, people and processes, we support clinical appropriateness review, provider collaboration and member engagement on behalf of more than 50 health plans, 40% of the Fortune 50 Employers, and 43 million members.

Today, our team includes more than 1,100 associates and features more than 600 licensed and board-certified physicians, nurses, and other healthcare professionals who engage with more than 330,000 health care providers across the country. These healthcare providers access our solutions and specialized clinical expertise through our online ProviderPortal and experienced contact center-based teams that is enabled by our business platform