Compliance Analyst - Quality Assurance (Hybrid)

Alliant Health Group, doing business as Alliant Health Solutions ("the Company"), is a family of companies that provides business and professional services supporting the effective administration of healthcare programs and funding to support healthcare improvement initiatives. The Company has been named a "Best Place to Work" for 2022, 2023, and 2024 as well as being named "Healthiest Employer".

Currently, Alliant seeks a compliance analyst - quality assurance. This position is a member of a professional multi-disciplinary work team responsible for the quality assurance reviews and monitoring of policy compliance for the South Carolina Department of Disabilities and Special Needs (SC DDSN) Quality Assurance Review program. In this position, you are responsible for conducting administrative review activities including provider administrative documentation and personnel or Human Resources (HR) record review, observation and evaluation of residential habilitation and day services, reviews of providers' plans of correction, follow-up reviews and special circumstance reviews. In addition, position conducts provider staff interviews.

The ideal candidate will:

• Perform desk review through analysis and review of previous administrative review findings and begins case activity log in developing the appropriate approach for the on-site review.
• Conduct on-site administrative reviews for the specified SC DDSN providers which includes some, but not all the following: exit and entrance sessions with the appropriate management and clinical staff from the provider location, staff interviews, and document(s) review.
• Notify providers in advance of upcoming on-site visits. Participates in entrance and exit interviews with providers.
• Make recommendations based on professional judgment and experience for the compliance with SC DDSN administrative standards, while substantiating recommendations with rationale.
• Analyze, interpret and documents appropriate determination administrative review outcomes utilizing the Med Guard review system.
• Supports the quality assurance review team in overall documentation management.
• Prepare timely, accurate, written letters/reports to providers/SC DDSN on initial on-site and follow-up desk/on-site review findings.
• Prepare weekly, monthly, and quarterly statistical reports as part of contract deliverables.
• Review additional information related to requests for follow-up reviews after initial findings and makes a recommendation based on professional judgment and experience for the compliance with SC DDSN administrative standards.
• Occasionally serve on panel of peers to provide professional expertise regarding standards of service delivery.
• Performs other tasks and duties assigned.

Knowledge, skills, abilities, education, experience and training required for the role include:

• Knowledge and ability to work independently; manage time; organize and prioritize work with competing deadlines to task or project completion
• Knowledge healthcare industry and customer service skills and ability to service all types of customers, including challenging customer
• Knowledge of critical thinking and ability to use of creative thinking, thorough analysis of problems, and use of innovative approaches to problem resolution
• Knowledge of administrative practices and procedures, and with SC DDSN programs
• Computer literate with knowledge of Microsoft Office Suite including Word and Excel, and experience with keyboarding or data entry
• Ability to communicate in verbal and written formats
• Ability to build rapport with internal and external customers, at all levels of an organization, in person or over the phone
• Ability to travel as needed by driving and/or going on airplane to customer or company meetings or other events
• Bachelor's degree in Social Work, Sociology, Psychology, Nursing or related field; and 2 to 3 years of years of health administration and/or compliance-quality assurance experience required, or any equivalent combination of education, training and experience that demonstrates the ability to perform the duties of the program
• Experience working in programs serving individuals with developmental disabilities and/or special needs is preferred

The Company offers a caring and supportive culture with work/life balance and great benefits!

In you are interested in joining a great team, select the "Apply" icon below!