Compliance Analyst

Prime Health Services • Franklin, TN

1d

About The Position

The Compliance Analyst reports to the Director of Compliance and works in one or two industry areas: workers’ compensation fee schedules or multiple-state Personal Injury Protection (PIP/Auto) regulations. The role researches legislative rules affecting professional, hospital, and pharmacy providers and translates those rules into requirements for the IT Development Team to implement in Prime Health Services’ bill review software. The analyst also maintains rules across jurisdictions and business lines, collaborates with product and development teams, performs testing, and supports state reporting requirements.

Requirements

• A bachelor's degree in health care administration, business, or a related field, or four years of direct healthcare experience.
• Understanding of first- and third-party Auto/PIP claims administration is required for work on 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 analysis results in a timely and meaningful way.
• Ability to work cooperatively with multidisciplinary teams and/or independently.

Nice To Haves

• At least two years of relevant experience in a physician practice, hospital, ancillary provider, health insurance company, or integrated delivery system.
• Knowledge of ICD-10-CM, CPT-4, Revenue Codes, DRGs, base rates, HCPCS coding, related governmental guidelines, and provider reimbursement methodologies.
• Strong knowledge of state jurisdictional regulations and rules for multiple lines of business, Auto, and workers’ compensation.

Responsibilities

• Independently research and interpret state or federal regulations for use across 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 with a high-deductible plan and 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.

What This Job Offers

• Job Type: Full-time