Compliance Analyst
About The Position
The Compliance Analyst supports the department in maintaining compliance with regulatory, accreditation, and internal standards. The position focuses on reporting, evidence gathering, data validation and trend review, operational follow-up, policy and procedure maintenance, audit preparation and support, and oversight of delegated entities. The analyst identifies process and quality improvement opportunities through data analysis, helps ensure data integrity, and supports audit readiness for internal audits and external reviews by organizations including CMS, DHCS, DMHC, and NCQA. The role works with department leadership and other teams on regulatory and internal reporting, audit activities, delegated-entity oversight, and special projects. It also maintains records and documentation related to compliance, audits, and regulatory activities. Some travel is required, including occasional overnight travel.
Requirements
- Bachelor’s degree in Healthcare Administration, Business Administration, Public Health, Data Science, or a related field; an equivalent combination of education and experience may be considered.
- 3–4 years of experience in healthcare or managed care, with a focus on grievance and appeals, compliance, or regulatory reporting preferred.
- Working knowledge of Medi-Cal, CMS, DHCS, and/or NCQA regulations and standards.
- Proficiency with applicable business software, including Microsoft Word, PowerPoint, and Excel, and a typing speed of 40 wpm.
- Valid California Driver’s License and proof of current automobile insurance compliant with the employer’s policies are required to operate a vehicle and travel for company business.
- Excellent oral and written communication skills.
- Strong analytical and problem-solving skills, including the ability to interpret data and trends.
- Excellent organizational skills, including the ability to prioritize assignments, maintain effective filing systems, and meet deadlines.
- Ability to work under minimal supervision and exercise independent judgment.
- Ability to handle sensitive personnel information with diplomacy and tact as required.
- Ability to interact effectively with executives and vendors and manage multiple tasks and deadlines.
- Ability to work independently within an interdisciplinary structure in a fast-paced environment while managing multiple priorities.
- Ability to use a computer keyboard and to obtain needed information from professionals by phone.
- Ability to function effectively with frequent interruptions and direction from multiple team members.
- Ability to lift, move, or carry objects weighing up to 10 lbs.
- Ability to travel up to 15%, including occasional overnight travel.
Nice To Haves
- Experience with Medi-Cal, Medicare, DHCS, DMHC, NCQA, CMS, or another regulatory healthcare environment is preferred.
- Experience in healthcare or managed care, particularly in grievance and appeals, compliance, or regulatory reporting, is preferred.
Responsibilities
- Analyze data to identify trends, root causes, and opportunities for process improvement.
- Develop actionable insights based on data analysis and internal reporting.
- Support preparation and compilation of monthly and quarterly reports on department performance, trends, and key metrics.
- Assist with regulatory reporting to state and national agencies, ensuring accuracy and timeliness.
- Collaborate with other departments to review and validate data used for regulatory and internal reports.
- Assist with preparation and coordination of internal and external audits, including gathering documentation and conducting pre-audit activities.
- Collaborate with leadership to help ensure department operations comply with CMS, DHCS, DMHC, and NCQA requirements.
- Monitor trends and collaborate with leadership to propose improvements to department processes.
- Review and analyze reports from delegated entities to assess compliance.
- Participate in the annual audit of delegated entities and assist with follow-up actions as needed.
- Support quality improvement initiatives by identifying operational enhancement opportunities based on data analysis.
- Collaborate with leadership on special projects related to audits, reporting, and regulatory compliance.
- Maintain accurate records and documentation for regulatory, audit, and compliance-related activities.
- Perform other duties as assigned.
- Provide a high level of service to clients, promote teamwork, maintain safe practices, and follow HealthPlan policies and procedures.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
