Compliance Analyst
Prime Health Services, Inc.•Franklin, TN
•Onsite
About The Position
The Compliance Analyst position reports to the Director of Compliance and functions in one or two industry arenas – 1) basic workers’ compensation fee schedules or 2) multiple state Personal Injury Protection (PIP/Auto) regulations, both focused on researching legislative rules for professional, hospital, and pharmacy providers in order to write requirements for the IT Development Team to implement within Prime Health’s bill review software.
Requirements
- Bachelor's Degree in health care administration, business, related field of study, or 4 years of direct experience in healthcare is required
- Understanding of Auto/PIP both first- and third-party claims administration is required to work Auto
- Demonstrated proficiency in Microsoft Office Suite (Excel, PowerPoint, Word)
- Excellent planning, communication, documentation, and organizational skills
- Advanced mathematical, analytical, and problem-solving skills
- Ability to interpret and summarize results of various analyses in a timely and meaningful way
- Ability to work cooperatively with multidisciplinary teams and/or independently
Nice To Haves
- 2+ years of relevant work experience in a physician practice, hospital, ancillary provider, health insurance company, or integrated delivery system is preferred
- Knowledge of ICD-10CM, CPT4, Revenue Codes, DRGs, base rates, HCPCS coding and related governmental guidelines and provider reimbursement methodologies is preferred
- Knowledge of state jurisdictional regulations and rules for multiple lines of business, auto and workers compensation is strongly preferred
Responsibilities
- Independently studies and interprets state or federal regulations for use in multiple product lines
- Manages and maintains rules in the PHS proprietary bill review software for multiple jurisdictions in multiple lines of business
- Collaborates with peers and other team members to elicit requirements, understand success factors and build out business requirements for PHS bill review products
- Performs unit and acceptance testing as necessary
- Work with the Development team to share understanding of business needs and ensure right outcomes
- Works with State Reporting team to ensure all state reporting requirements are met
- Performs other duties as assigned
Benefits
- Medical Insurance (high-deductible plan with HSA)
- Dental and Vision Insurance
- Company-paid short-term & long-term disability
- Company-paid group term life insurance
- Generous PTO Policy
- Employee recognition programs
- Corporate office amenities
- Frequent employee events
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
Upload and Match Resume
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
