Compliance Analyst

Overview

The compliance analyst plays a key support role in ensuring the department maintainscompliance with regulatory, accreditation, and internal standards. This role is responsible forreporting, evidence gathering, data validation, trend review, operational follow-up, assisting withpolicy and the procedure maintenance, audit preparation and support, and oversight of delegatedentities. The compliance analyst also plays a critical role in identifying process and qualityimprovement opportunities through data analysis ensures data integrity, and audit readiness. Thisis a dynamic and multifaceted position that supports various compliance activities to maintainorganizational readiness for internal audits, external reviews - such as Centers for Medicare &Medicaid Services (CMS), California Department of Health Care Services (DHCS), Departmentof Managed Health Care (DMHC) and National Committee for Quality Assurance (NCQA), anddelegate oversight.

Responsibilities

Essential Duties and Responsibilities

 Analyzes data to identify trends, root causes, and opportunities for process improvement. Develops actionable insights based on data analysis and internal reporting. Supports the preparation and compilation of monthly and quarterly reports on departmentperformance, trends, and key metrics. Assists with regulatory reporting to state and national agencies, ensuring accuracy andtimeliness. Collaborates with other departments to review and validate data used for regulatory andinternal reports. Assists in the preparation and coordination of internal and external audits, includinggathering documentation and conducting pre-audit activities. Collaborate with leadership to ensure department operations remain in compliance withCMS, DHCS, DMHC, and NCQA requirements. Monitors trends and collaborates with leadership to propose improvements to departmentprocesses. Reviews and analyzes reports from delegated entities to ensure compliance. Participates in the annual audit of delegated entities and assists with follow-up actions asneeded. Supports quality improvement initiatives by identifying areas for operationalenhancements based on data analysis. Collaborates with the leadership on special projects related to audits, reporting, andregulatory compliance.

 Maintains accurate records and documentation for all regulatory, audit, and compliancerelated activities. Other duties as assigned.

Qualifications

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Education and Experience

Bachelor’s degree in Healthcare Administration, BusinessAdministration, Public Health, Data Science, or related field; 3-4 yearsof experience in the healthcare or managed care, with a focus ongrievance and appeals, compliance, or regulatory reporting preferred.Experience with Medi-Cal, Medicare, DHCS, DMHC, NCQA, CMS,or other regulatory healthcare environment preferred. An equivalentcombination of education and experience may be considered.

 

Special Skills, Licenses and Certifications

Working knowledge of Medi-Cal, CMS, DHCS and/or NCQAregulations and standards. Highly proficient in applicable businesssoftware applications including PC usage, Microsoft Word,PowerPoint, Excel, and typing speed of 40 wpm. Valid CaliforniaDriver's License and proof of current automobile insurance compliantwith Partnership’s policies are required to operate a vehicle and travelfor company business. 

 

Performance Based Competencies

Excellent oral and written communication skills. Strong analytical andproblem-solving skills with the ability to interpret data and trends.Excellent organizational skills with the ability to prioritizeassignments, maintain effective filing systems, and meet deadlines.Ability to work under minimal supervision and exercise independentjudgment. Diplomacy and tact in handling sensitive informationregarding personnel affairs as required. Ability to interact withexecutives and vendors effectively, handling all assignments withefficiency. Must be able to handle multiple tasks and meet deadlines.Excellent judgment. Ability to work within an interdisciplinarystructure and function independently in a fast-paced environment whilemanaging multiple priorities and deadlines. Strong organizational skillsrequired. 

 

Work Environment And Physical Demands

Ability to use a computer keyboard. Ability to prioritize workload andinitiate action to acquire needed information from professionals byphone. Ability to function effectively with frequent interruptions anddirection from multiple team members. More than 70% of work time isspent in front of a computer monitor. Must be able to lift, move, orcarry objects of varying size, weighing up to 10 lbs. Some travelrequired (up to 15%) including occasional overnight.

 

All HealthPlan employees are expected to:▪ Provide the highest possible level of service to clients;▪ Promote teamwork and cooperative effort among employees;▪ Maintain safe practices; and▪ Abide by the HealthPlan’s policies and procedures, as they may from time to time beupdated.

 

HIRING RANGE:

 

$96,970.04 - $121,212.56

IMPORTANT DISCLAIMER NOTICEThe job duties, elements, responsibilities, skills, functions, experience, educational factors andthe requirements and conditions listed in this job description are representative only and notexhaustive or definitive of the tasks that an employee may be required to perform. The employerreserves the right to revise this job description at any time and to require employees to performother tasks as circumstances or conditions of its business, competitive considerations, or workenvironment change.