Healthcare Claims Compliance Remediation Analyst / Hybrid

Job ID: 255733    Posted 3/25/2024


Location: New York, New York


Job Type: Direct Hire


Category: HIM


Position: 255733




Salary Low: $81000 - Salary High: $91000


Duration: 2 Weeks



Job Description

Claims Compliance Remediation Analyst – Hybrid ( 2 or 3 days a week working in Manhattan Office and 2 to 3 days a week working remotely)
About the Health Plan:
For over 30 years, this health plan has been dedicated to fostering strong relationships with members and providers, aiming to empower New Yorkers to lead healthier lives. They deliver the highest quality healthcare services across Bronx, Brooklyn, Manhattan, Queens, and Staten Island through a comprehensive range of products.
Position Overview:
As a Claims Compliance Remediation Analyst, you will play a crucial role in supporting the Director of Claims Support to ensure compliance with CMS and NYSDOH regulatory entities. Your responsibilities will include coordinating efforts with the Office of Corporate Compliance, representing the Claims Department during regulatory audits, and ensuring documents and processes remain up-to-date and compliant.
Key Responsibilities:

  • Collaborate with the Office of Corporate Compliance to align Claims Department objectives with company requirements.
  • Oversee and facilitate the processing of regulatory requests, escalating performance issues to Claims Department management.
  • Support corporate training initiatives on claims module creation and rollout.
  • Consolidate significant events for regular reporting via a “Claims Compliance Newsletter.”
  • Coordinate timely responses to claims corrective action plans and execute remediation plans.
  • Manage other projects as needed.

Minimum Qualifications:

  • Bachelor’s degree required.
  • 3-5 years of health plan compliance/regulatory experience.
  • 1+ year of medical coding experience with sustained coding quality knowledge.
  • Strong familiarity with CMS and NYS audit protocol.
  • Experience in managed care, Medicare, federal regulations, quality improvement, and compliance oversight.
  • Ability to research authoritative citations related to coding, compliance, and additional reporting needs.
  • Solid understanding of health insurance law as it relates to compliance.

Salary and Benefits:
The salary range for this position is $81,000 to $91,000, accompanied by excellent benefits, including a pension plan.


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Why Us?

At RCM Health Care Services, we redefine healthcare staffing, creating an environment where your career thrives and flourishes. Our commitment to your success is woven into the fabric of our culture, offering diverse opportunities for both seasoned professionals seeking challenges and newcomers ready to make their mark. As a part of the RCM family, you'll experience more than just a job – you'll find a platform for continuous growth and fulfillment.

We have cultivated an ecosystem where healthcare professionals not only find rewarding career opportunities but also a community that values their skills and dedication. Your success is our priority, and our collaborative environment ensures you're never alone on your professional journey. Competitive salaries and comprehensive benefits reflect our dedication to your well-being, allowing you to focus on what matters most – delivering exceptional care. Join RCM Health Care Services, a trusted partner with a proven track record since 1975 and embark on a journey where your path to a fulfilling healthcare career truly begins.

About Us

With a legacy spanning over 45 years, RCM Health Care Services is a leader in connecting healthcare professionals with rewarding career opportunities. Our foundation is built on cultivating relationships with school districts, setting the stage for our expansion into placing providers across diverse facility types. As we evolved, our expertise diversified across various divisions including School Services, Behavioral Health/ABA, Travel, Nursing, Therapy, HIM, Permanent Placement, Foreign Recruitment, Locums Tenens, and much more.
Our mission is clear: to elevate healthcare standards by empowering talented healthcare professionals and forming strategic partnerships with top-tier healthcare institutions and schools across the country. We proudly hold the Joint Commission Gold Seal of Approval, showcasing our commitment to the highest standards in healthcare.
Our commitment goes beyond filling positions; we actively build careers, foster growth, and make a profound difference in the lives of both our candidates and the patients they serve.