Compliance Analyst
Prime Health Services, Inc.•Franklin, TN
About The Position
The Compliance Analyst reports to the Director of Compliance and works in one or two industry arenas: basic workers’ compensation fee schedules or multiple state Personal Injury Protection (PIP/Auto) regulations. The role researches legislative rules for professional, hospital, and pharmacy providers and translates them into requirements for the IT Development Team to implement in Prime Health’s bill review software. The analyst also maintains jurisdictional rules, collaborates on business requirements, tests products, and supports state reporting compliance.
Requirements
- Bachelor’s degree in health care administration, business, or a related field, or four years of direct experience in healthcare.
- Understanding of Auto/PIP first- and third-party claims administration is required for work in Auto.
- Demonstrated proficiency in Microsoft Office Suite, including Excel, PowerPoint, and Word.
- Excellent planning, communication, documentation, and organizational skills.
- Advanced mathematical, analytical, and problem-solving skills.
- Ability to interpret and summarize analytical results in a timely and meaningful way.
- Ability to work cooperatively with multidisciplinary teams and/or independently.
Nice To Haves
- Two or more years of relevant work experience in a physician practice, hospital, ancillary provider, health insurance company, or integrated delivery system.
- Knowledge of ICD-10CM, CPT4, Revenue Codes, DRGs, base rates, HCPCS coding, related governmental guidelines, and provider reimbursement methodologies.
- Knowledge of state jurisdictional regulations and rules for multiple lines of business, auto, and workers’ compensation.
Responsibilities
- Independently study and interpret state or federal regulations for use in multiple product lines.
- Manage and maintain rules in the proprietary bill review software for multiple jurisdictions and lines of business.
- Collaborate with peers and other team members to elicit requirements, understand success factors, and develop business requirements for bill review products.
- Perform unit and acceptance testing as necessary.
- Work with the Development team to explain business needs and help ensure appropriate outcomes.
- Work with the State Reporting team to ensure state reporting requirements are met.
- Perform other duties as assigned.
Benefits
- Medical insurance, including a high-deductible plan with HSA.
- Dental and vision insurance.
- Company-paid short-term and long-term disability.
- Company-paid group term life insurance.
- Generous PTO policy.
- Employee recognition programs.
- Corporate office amenities.
- Frequent employee events.
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What This Job Offers
Job Type
Full-time
