Contract Compliance Analyst (Hybrid)

Kaiser Permanente • Portland, OR

214d

About The Position

The Contract Compliance Analyst is accountable to ensure Kaiser Permanente Northwest's (KPNW) provider, facility and health care benefit managers' (HCBM) contract filings meet regulatory compliance with the Washington State Office of the Insurance Commissioner (WA OIC). The Contract Compliance Analyst manages KPNW's SERFF filing processes from analytical review, preparation and submission, to tracking, assessing and resolving active suspensions, to compliant disposition. The position will lead and manage contract compliance projects and support regulatory audit responses and tracking. The Contract Compliance Analyst collaborates with leadership to ensure successful implementation of regulatory changes and policies impacting our Provider Contracting team. The professional in this position has the ability to maintain confidentiality, combine technical skills with business acumen, and achieve outstanding results through strategic problem-solving is crucial for this position.

Requirements

• Bachelor's degree in business, legal, health care administration or equivalent experience.
• Five (5) years' experience in managed care contracting, legal administration or paralegal, health plan administration, or other comparable experience.
• One (1) year experience reviewing and interpreting laws and regulations, accreditation requirements (e.g., NCQA), analyzing business impacts and communicating to inform strategies.
• Ability to review and analyze complex documents, and regulatory requirements to identify potential issues/areas of non-compliance.
• Prior experience in provider contracting, insurance, or a related field would be a significant asset.
• Demonstrate adaptability and ability to succeed in a complex, demanding, and dynamic work environment.
• Capable of handling sensitive information with an elevated level of discretion and confidentiality.
• Proficient use of contract management and provider database software applications.

Nice To Haves

• Three (3) years' experience creating and submitting filings within the System for Electronic Rates & Forms Filing (SERFF) system.
• Eight (8) years' experience in managed care contracting, legal administration or paralegal, health plan administration, or other comparable experience.
• Advanced knowledge of applicable federal and state laws and regulations related to healthcare.
• Significant experience in the review and drafting of contract language, health plan operations (referrals, prior-authorization, product design) highly preferred.

Responsibilities

• Accountable for end-to-end filings for all provider and facility contracts, amendments, templates, and health care benefit manager (HCBM) filings with the WA OIC and daily monitoring of regulatory response to filings.
• Reviews contractual documents and completes analyst checklists to ensure state and federal regulatory requirements are met.
• Communicates to internal stakeholders on changes necessary for contracts to be considered compliant.
• Prepares contract documents for filing ensuring finished contracts reflect Kaiser Permanente's business, legal, regulatory, and reputational interests.
• Creates compliant SERFF filings for submission to the WA OIC.
• Develops filing description to accompany SERFF filings, anticipating issues, and positively influencing state regulator review.
• Coordinates with Kaiser Permanente's regional and national provider contracting staff, Legal, Regulatory and Compliance departments to develop responses to active suspension comments from the regulator.
• Engages and coordinates input from appropriate subject matter experts to achieve timely and strategically appropriate responses.
• Analyzes, collaborates, and monitors, provider network management HCBM and related support of all associated WA OIC filings.
• Supports review and implementation of contract templates, ensures they are comprehensive, up to date and comply with the most current state and federal regulations.
• Assists with testing and validation of new contract templates in the CM testing environment prior to the release in CM production.
• Participates in CM testing cycles for new system upgrades or enhancements as it pertains to the CM Library Manager functions.
• Supports a variety of priority contract compliance responsibilities, including facilitation of internal audit, state, and federal audits/assessments.
• Responsible for monitoring, managing, analyzing, and auditing contractual agreements, and their associated workflows, within department's contract management (CM) system.
• Creates reporting of department's contractual agreements to ensure integrity and completeness of contract lifecycle, metadata and reportable information memorialized within CM.

Benefits

• 15% employer contribution to retirement programs, including pension
• 90% employer-paid health plan
• Tuition Reimbursement
• Child Care Benefits
• Flexible Work Schedules
• Paid Parental Leave
• Self-Care Days + Paid Time Off

What This Job Offers

• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Education Level: Bachelor's degree