Sr. Compliance Reporting Analyst

Cohere Health

9h • Remote

About The Position

This role will be primarily responsible for performing compliance reporting reviews and audits to ensure compliance with federal and state regulations, NCQA, URAC and client contractual requirements. This role will also assist with data collection, analysis and reporting for process improvement efforts. The Sr. Compliance Reporting Analyst will plan, coordinate, and conduct compliance reporting audits at the direction of the Manager, Compliance Programs, the Chief Compliance Officer and the Quality, Security and Compliance Committee. Scope includes reviewing / auditing of all CMS required data tables, client-required or mandatory reports against applicable rules and regs. The Sr. Compliance Reporting Analyst position will also include quality assurance functions and quality improvement.

Requirements

• Associate’s/Bachelor’s degree preferred or equivalent work experience.
• Minimum 2 years in a healthcare auditing, reporting or operations role
• Strong attention to detail and accuracy in fast-paced environment
• Strong oral and written communication skills
• Strong interpersonal and leadership skills
• Certification in Healthcare Compliance (CHC)
• Intellectual curiosity and ability to research issues, solve problems and develop solutions
• Ability to be flexible and evolve the role to accommodate new operational approaches
• Ability to generate new ideas, iterate on existing ones and identify trends & patterns that improve clinical quality and ensure compliance
• Ability to thrive in high-growth, rapidly changing health-tech environment
• Cross-functional collaboration skills

Responsibilities

• Ensures compliance with regulations by examining and analyzing records, reports, operating practices, and documentation; will provide recommendations for improvement and coaching as necessary
• Manages quality assurance for monthly ODAG universe submissions; reviews client validation results and ensures appropriate follow-up and closure of issues; manages any subsequent corrective actions and ensures appropriate root cause analysis is conducted.
• Review and manage the collation of quarterly Part C report and other client-required and mandatory report submissions; ensure timely communication of issues to process owners; track findings to resolution.
• Completes audit work papers and memorandums by documenting audit findings
• Maintains excellent documentation of all audits, methodologies employed, results, corrective action plans implemented, and monitoring.
• Assists with non-clinical elements of client pre-delegation audits and accreditation.
• Communicates audit progress and findings by preparing reports, discussions with management and providing information in meetings
• Presents audit findings to stakeholders as needed
• Analyzes quality assurance and compliance data and assists in preparing reports.
• Assists in designing and implementing solutions to quality management issues.
• Maintains a strong working knowledge of state and federal legislation, statutes and regulations, as well as various client service level agreements
• Other tasks as assigned

Benefits

• Medical, dental, vision, life, disability insurance, and Employee Assistance Program
• 401K retirement plan with company match
• flexible spending and health savings account
• Flexible Time Off + Company Holidays
• Up to 14 weeks of paid parental leave
• Pet insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 251-500 employees