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Senior Compliance Investigator

Canada-Alberta-Edmonton

1505816

Job Description

Medical Health 3

 

Alberta Health, Edmonton. To learn more about Alberta Health and what we have to offer, follow this link: http://www.health.alberta.ca/

 

Are you an analytical mind with a passion for data? Put your investigative skills, medical expertise and enthusiasm for compliance to work in our Investigations Unit in the Compliance and Monitoring Branch.

 

Reporting to the Manager of Investigations, you would be responsible for supervising two Compliance Analysts in managing the initiation and execution of compliance projects and reviews. You will also be providing clinical expertise in the completion of various compliance reviews related to Alberta Health Care Insurance Plan (AHCIP) claims, including Private Clinics, Primary Care Initiative and Alternative Relationship Plans. Strong attention to detail and analytical skills are required to provide quality assurance to examine in-depth data analysis of specific claims data. Expert knowledge of medical terminology and medical and surgical procedures is necessary to review various medical documentation in conjunction with billing claims to determine appropriate payments. Using tact and diplomacy, you are the primary contact between the department and the practitioner and/or the practitioner's legal counsel to communicate during the course of a compliance review and negotiation to recover the identified overpayments. By using professional judgment and sound problem solving skills, this role is key in enhancing processes, creating documentation, building audit and fraud cases, educating practitioners and their employees about acceptable claim practices, and supporting the enforcement strategy with the Special Investigations Unit.

 

Competencies required for this position are:

 

System thinking: Compliance reviews safeguard public funds by promoting compliance to the applicable legislation related to the Alberta Health Care Insurance Plan (AHCIP).

 

Creative Problem Solving: Identify innovative and effective solutions to ensure compliance to legislation, regulations and governing rules through investigations.

 

Agility: Anticipate, assess, and readily adapt to changing priorities, maintain resilience in times of uncertainty and effectively work in a changing environment.

 

Drive for Results: Effectively manage numerous compliance reviews by conducting on-site audits of provider offices/hospitals to retrieve medical records, review records, communicate, negotiate and provide education as needed.

 

Build Collaborative Environments: Lead and supervise a team of Compliance Analysts and collaborate across divisions/units to support Ministry/branch objectives.

 

Salary: $3,143.66 - $4,005.50 bi weekly ($82,049 - $104,543 annually). Closing Date: April 20, 2017. Job ID #1041650

 

Qualifications: A para-medical degree (Nursing) and a minimum of three years of related experience is required. Must be a regulated member of the appropriate college as required by the Health Professions Act. Experience with Medical terminology, medical and surgical procedures, data analysis and written communication (report writing) is preferred. Experience with the Schedule of Medical Benefits and allied health practitioners' schedules of benefits, the Alberta Health Care Insurance Act, the Health Information Act and the Health Care Protections Action is desired. Audits, investigations and negotiation experience would be considered an asset. A valid Alberta driver's license is required. Equivalences will be considered on the basis of one year of education for one year of experience or one year of experience for one year of education.

 

Competencies are behaviors that are essential to reach our goals in serving Albertans. We encourage you to have an in depth understanding of the competencies that are required for this opportunity and to be prepared to demonstrate them during the recruitment process. The link below will assist you with understanding competencies:

http://www.chr.alberta.ca/Practitioners/?file=learning/apscompetencies/titlepage&cf=9

 

This is a one year temporary opportunity with a possibility of extension based on operation needs. This competition may be used to fill a number of current and future vacancies in various ministries throughout the Government of Alberta.

 

What we offer:

-Comprehensive benefits plan: http://www.chr.alberta.ca/Employees/DocList122.cfm

 

-Pension plan: http://www.pspp.ca/

 

Online applications are preferred via www.jobs.alberta.ca. If you are unable to submit an electronic version of your resume, please submit your resume, quoting the Job ID, to: Alberta Health, Human Resources, 2nd Floor, ATB Place North, 10025 Jasper Avenue, Edmonton, AB, T5J 2N3. Applicants who apply online will be able to track the status of the competition.

 

Note: As only one file can be uploaded, please ensure your cover letter, resume, and any other related documents are submitted in one file. Applicants being considered may be contacted via e-mail with information about the next stage in the process.

 

It is required that applicants who have obtained educational credentials from outside of Canada and have not had them previously assessed, obtain an evaluation of their credentials from the International Qualifications Assessment Service (IQAS) - http://work.alberta.ca/immigration/international-qualifications-assessment-service.html It is recommended that applicants include the assessment certificate from IQAS or any other educational assessment service as part of their application.

 

If you require any further information on this job posting, please call our Human Resource office at: (780) 427-1524. We thank all applicants for their interest. All applications will be reviewed to determine which candidates' education and experience best meets the needs of the position. Only individuals selected for interviews will be contacted. If this competition is closed as per the closing date noted above, please continue to check http://www.jobs.alberta.ca for a listing of current career opportunities with the Government of Alberta.

 

Please follow us on LinkedIn: http://www.linkedin.com/company/government-of-alberta

 

Although this competition is closing on April 20, 2017, please continue to check jobs.alberta.ca for all career opportunities with the Government of Alberta.

 

www.jobs.alberta.ca


Contact Information

Posting Date: 07-Apr-2017Medical/Healthcare Permanent, Full-Time Open 1 ASAP
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