Under the supervision of the Compliance Officer, the Compliance Analyst coordinates, schedules, and performs internal reviews and audits, documents results, and trains/educates other internal operational areas regarding compliance with applicable ethical standards, laws, regulations, and other external/contractual requirements related to the provision of behavioral healthcare and ABA therapy to children with autism spectrum disorders. Reviews ABA billing, coding, and clinical documentation to ensure billing and coding compliance, and coordinates responses to payor requests. Supports the organization’s overall efforts to maintain an effective compliance program with focus on the Seven Elements of an Effective Compliance Program as outlined by OIG. This position may also participate in organizational risk analyses or other corporate ethics and compliance-related activities.

• Proactively maintains awareness of laws, regulations, and other external/contractual requirements and performance standards applicable to the company’s operations.
• Collects, analyzes, and summarizes data using Word, Excel, PowerPoint and other tools to prepare informative reports and identify trends.
• Performs internal reviews and audits – including coding and bililng audits – and collaborates with internal staff, to ensure billing practices follow company policies and procedures, applicable laws, regulations, contractual requirements, commonly accepted billing practices, and internal quality standards.
• Identifies gaps in, and assists in writing, policies and procedures, risk assessments, and work plans.
• Assists in developing and delivering internal training and communications on laws, regulations, contracts, or compliance and ethics-related topics.
• Identifies opportunities for improvements in business processes and assists with communicating or training staff on improving efficiency, effectiveness, or compliance; tracks trends to determine if improvements are effective.
• Assists the Compliance team in administrative tasks such as organizing, hosting, and facilitating meetings, developing meeting agendas, presentations, and taking meeting minutes.
• Receives, coordinates, evaluates for adequacy, and responds to incoming requests for client information from payor entities in a timely manner.
• Establishes and maintains mutually beneficial working relationships; acts as a liaison for the Compliance department, interfacing with other operational area staff of all levels and all functions.
• Other duties as assigned

• Bachelor’s degree in a healthcare-related or behavioral health-related field.
• Experience with healthcare laws, regulations, contracts, and health insurance/managed care concepts.
• Working knowledge of compliance issues in healthcare and managed care environments, esp. ABA therapy.
• Ability to understand medical and behavioral healthcare information and terminology, including CPT and ICD codes.
• Excellent interpersonal, written, and oral communication skills to include typing, document formatting, presentation development, one-on-one meetings, and hosting in-person and online web meetings.
• Ability to self-prioritize, independently seek solutions and information; ability to execute multiple tasks in a fast-paced environment with changing priorities.
• Demonstrated professional integrity and ethical decision making.
• Ability to maintain strict confidentiality.
• Familiarity with Microsoft Office suite of applications, especially Outlook, Word, PowerPoint, and Excel.
• Analytical and collaborative mindset.
• Attention to detail.

Preferred Requirements

• Experience working in a healthcare ethics, compliance, or audit department handling sensitive and confidential company, patient, and employee information; Experience with responsible handling of privileged electronic and physical access.
• Coding specialist certification.
• Experience with a behavioral healthcare provider organization, especially ABA therapy providers.
• Familiarity with the Seven Elements of an Effective Compliance Program.
• 3 years experience in a healthcare or health insurance setting.

As a representative of the Compliance team, the Compliance Analyst goes beyond simply demonstrating ethical and compliant behavior but strives to be a model for others and an advocate for ethical and compliant behaviors. Candidates will support BI’s organizational values of: Caring, Accountable, Collaborative, and Family-Focused. Candidates will adhere to all BI’s policies and procedures, Code of Conduct, HIPAA rules, documentation standards, etc.