ACA Senior Compliance Analyst PCHP

Parkland Health

4d•Hybrid

About The Position

The ACA Senior Compliance Analyst is responsible for the ongoing management of Health Plan compliance policies, procedures, and guidelines. The position supports the development, maintenance, review, and assessment of PCHP’s compliance program; evaluates changes in regulatory requirements; and coordinates efforts to operationalize those requirements across the Health Plan. The role applies Affordable Care Act and Marketplace regulations, coordinates regulatory filings and submissions, tracks compliance activities and risks, and develops reports for leadership. It also supports compliance training and communications, collaborates with functional areas across PCHP, and promotes ethical conduct and adherence to organizational and regulatory requirements. The position follows a hybrid schedule, working full-time days from 8 a.m. to 4 p.m., Monday through Friday.

Requirements

Bachelor’s degree in Healthcare Administration, Business Administration, or a related field.
Five years of relevant professional experience as a healthcare compliance professional.
Experience designing and implementing organizational reporting processes and structures that enhance and encourage complete and accurate tracking, coordination, and reporting of compliance activities and events.
HCCA Certified in Healthcare Compliance (CHC) required within two years from the date of entry into the position.
Excellent verbal and written communication skills, including the ability to communicate professionally across disciplines and explain complex information in understandable terms.
Strong interpersonal and conflict-resolution skills and the ability to establish and maintain effective working relationships across and beyond the organization.
Excellent analytical and problem-solving skills.
Strong time-management and organizational skills, including the ability to manage multiple demands and respond to rapidly changing priorities.
Ability to write clearly and succinctly with a high level of attention to detail.
Proficient computer and Microsoft Office skills and the ability to learn new software programs.
Knowledge of the Affordable Care Act (ACA), Federally-facilitated Marketplace and Qualified Health Plan (QHP) requirements, NCQA, the Texas Insurance Code, and applicable federal regulations (45 CFR).

Nice To Haves

Master’s degree in Healthcare Administration, Business Administration, or a related field is preferred.
Seven years of experience in a comparable position working in commercial or Marketplace (ACA) health insurance, or with a health insurance issuer offering Qualified Health Plans, may be considered in lieu of a degree.

Responsibilities

Ensure work complies with regulatory and accreditation standards and contractual requirements.
Understand and apply ACA and Marketplace regulations, including 45 CFR Parts 153, 155, and 156, the Texas Insurance Code, TAC, and applicable CMS and Texas Department of Insurance guidance.
Prepare, coordinate, and track regulatory filings and submissions, including TDI form and rate filings through SERFF, QHP certification and recertification materials, and required CMS/Marketplace data submissions.
Attend regulatory agency meetings and track completion of compliance-related action items.
Develop compliance committee agendas, presentations, and minutes.
Maintain logs and reporting for internal monitoring and compliance risks.
Assist with creating and implementing the compliance risk assessment and compliance monitoring and auditing work plan.
Track and monitor Health Plan compliance using data analytics.
Assist with regulatory reporting related to fraud, waste, and abuse activities.
Develop compliance reports, including dashboards, tracking logs, and summary reports communicating compliance-program status to leadership.
Assign and track completion of regulatory notices, rule changes, and guidance issued by CMS and TDI.
Assist in developing and distributing topic-specific education to Health Plan personnel based on identified risks or changes in law or regulation.
Manage the compliance training program, including identifying curriculum gaps and reporting.
Assist in developing and creating internal compliance communications and newsletters.
Build and maintain collaborative working relationships across PCHP functional areas, including legal, contracting, provider relations, member relations, utilization management, quality monitoring, and information systems.
Promote and support a culturally welcoming and inclusive work environment.
Act with integrity and ethical standards while adhering to Parkland’s mission, vision, and values; follow organizational policies, procedures, and guidelines.
Complete assigned training, self-appraisal, and annual health requirements on time; adhere to hybrid work schedule requirements; and attend required meetings and town halls.
Recognize and communicate ethical and legal concerns through established channels; independently complete assigned work on time and respond to information requests promptly.
Maintain confidentiality.
Identify ways to improve work processes and customer satisfaction, recommend improvements to the supervisor, and implement and monitor results as appropriate.
Stay informed about developments and trends in the field through professional learning and participation, and integrate knowledge gained into current work practices.
Maintain knowledge of applicable rules, regulations, policies, laws, and guidelines; develop effective internal controls and seek advice as needed to ensure proper understanding.