Clinical Outcomes Analyst, Sr. jobs in Fresno, CA

Education and Work Experience:

• Associate’s/Technical Degree or equivalent combination of education/related experience: Required
• Bachelor's Degree: Preferred
• Five years’ relevant experience: Preferred

Essential Functions:

• Works with contract specialists, corporate compliance departmental staff, legal counsel and paralegals to determine if facilities are processing physician contracts according to policy. Reviews hospital physician contract lists to ensure contracts are renewed properly and that no gaps occur with respect to the physician contract and services rendered.
• Reviews facility accounts payable transactions for physicians. Communicates desk audit findings to management and ensures hospitals respond to the findings. Monitors and maintains the internal corporate compliance reporting process to ensure organization employees and agents can report ethics and compliance concerns without fear of retaliation.
• Coordinates, reviews, and prepares physician contract information for presentation to the organization's Compliance Committee. Evaluates internal control systems designed to detect significant instances or patterns of illegal or unethical conduct by employees or agents. Provides technical support and consultation to executive management to help determine appropriate responses to potential compliance violations.
• Maintains the Hotline reporting database, participates in the Hotline investigations, and helps ensure issues are resolved in an efficient and timely manner. Summarizes compliance reports for presentation to the organization's legal board and/or its appointed subcommittee.
• Monitors legislation and regulations involving compliance-related issues, such as physician contracting, patient billing and coding, etc. Communicates the organization's Code of Conduct to all employees, refreshes employees’ knowledge of the Code of Conduct, and addresses areas of compliance risk concerning specific employee populations.
• Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.