Parkland Community Health Plan’s (PCHP’s) Senior Compliance Analyst reports to the Director Health Plan Compliance and will be responsible for the ongoing management of the Health Plan compliance policies, procedures, and guidelines. This position supports the ongoing development, maintenance, review, and assessment of PCHP’s compliance, evaluates changes in regulatory requirements and coordinates efforts to operationalize them across the Health Plan. The Senior Compliance Analyst is responsible for the ongoing tracking and monitoring of Health Plan compliance using data analytics.
Bachelor’s degree in Healthcare Administration, Business Administration, or related field.
Master’s degree in Healthcare Administration, Business Administration or related field is preferred.
Five years of relevant professional experience as a healthcare compliance professional.
Experience in designing and implementing organizational reporting processes and structures that enhance and encourage complete and accurate tracking, coordination and reporting of compliance activities and events.
Equivalent Education and/or Experience
May have an equivalent combination of education and experience to substitute for both the education and the experience requirements.
Must hold professional certification as Certified Healthcare Compliance (CHC) or Certified Compliance Professional (CCP) or obtain within 24 months of placement in job.
Skills or Special Abilities
In-depth knowledge of health plan compliance, operations, standards, policies, and procedures.
General knowledge of a broad spectrum of health plan laws and regulations.
Strong critical thinking skills.
Ability to evaluate complex health plan compliance issues, seek additional guidance when necessary and make appropriate recommendations.
Excellent organizational and planning skills.
Must be able to garner the trust of others by providing practical, sound, accurate and timely support.
Ability to meet strict and rigorous internal and governmental reporting requirements and deadlines.
Highly organized with great attention to detail.
Strong interpersonal and prioritization skills.
Excellent verbal and written communication skills that are effective at all levels.
Must demonstrate a high degree of personal integrity and ethical standards.
High proficiency in Microsoft Excel, Word, and Access applications.
Supports the ongoing operation and sustainability of the Health Plan from a compliance perspective, which includes conducting analysis, documenting findings, and summarizing the complexities in a manner that is easily understood, actionable and supports the Health Plan’s effectiveness.
Implements and manages a comprehensive system for the collection, tracking and reporting of required compliance events and activities as provided for by PCHP internal requirements, Texas Department of Insurance regulations and PCHP’s contract with the Health and Human Services Commission.
Manages and administers a compliance/regulatory matters database for PCHP to include monitoring and auditing the database for monthly reporting to team members including execution of workflow process for review of events.
Works on fraud, waste and abuse program including working with data analytics to identify patterns of potential fraud, waste, and abuse.
Manages the Health Plan’s Compliance Program Policy and Procedure lifecycle process. Responsible for the development of the Health Plan’s compliance and privacy related documents including stakeholder input, review, and approval. Facilitates and/or provides subject matter expertise to recommend updates to policies and procedures, best practices, and implementation guidance.
Builds and maintains strong collaborative working relationships across PCHP’s functional areas including legal, contracting, provider relations, member relations, utilization management, quality monitoring and information systems.
Builds and maintains strong collaborative working relationships across PCHP’s delegated entities including third party administration, disease management, behavioral health, vision services and pharmacy services.
Assists in developing and disseminating topic-specific education to Health Plan personnel based on identified risks or changes in law or regulation.
Uses data analytics to develop and track Health Plan performance about compliance standards. Works collaboratively with leadership to validate efficacy of the data to support compliance with legal and regulatory requirements.
Implements an organizational framework for monitoring the federal and state regulatory landscape related to the Health Plan and to identify new developments and changes that impact the organization. Works with leaders to communicate requirements and responsibilities.
Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of PCHP.
Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding.
Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.
Nearest Major Market: Dallas
Nearest Secondary Market: Fort Worth
Job Segment: Patient Care, Healthcare Administration, Behavioral Health, Public Health, Pharmacy, Healthcare