Compliance Analyst

Overview:

The compliance analyst plays a key support role in ensuring the department maintains

compliance with regulatory, accreditation, and internal standards. This role is responsible for

reporting, evidence gathering, data validation, trend review, operational follow-up, assisting with

policy and the procedure maintenance, audit preparation and support, and oversight of delegated

entities. The compliance analyst also plays a critical role in identifying process and quality

improvement opportunities through data analysis ensures data integrity, and audit readiness. This

is a dynamic and multifaceted position that supports various compliance activities to maintain

organizational readiness for internal audits, external reviews - such as Centers for Medicare &

Medicaid Services (CMS), California Department of Health Care Services (DHCS), Department

of Managed Health Care (DMHC) and National Committee for Quality Assurance (NCQA), and

delegate oversight.

Responsibilities

Essential Duties and Responsibilities

 Analyzes data to identify trends, root causes, and opportunities for process improvement.

 Develops actionable insights based on data analysis and internal reporting.

 Supports the preparation and compilation of monthly and quarterly reports on department

performance, trends, and key metrics.

 Assists with regulatory reporting to state and national agencies, ensuring accuracy and

timeliness.

 Collaborates with other departments to review and validate data used for regulatory and

internal reports.

 Assists in the preparation and coordination of internal and external audits, including

gathering documentation and conducting pre-audit activities.

 Collaborate with leadership to ensure department operations remain in compliance with

CMS, DHCS, DMHC, and NCQA requirements.

 Monitors trends and collaborates with leadership to propose improvements to department

processes.

 Reviews and analyzes reports from delegated entities to ensure compliance.

 Participates in the annual audit of delegated entities and assists with follow-up actions as

needed.

 Supports quality improvement initiatives by identifying areas for operational

enhancements based on data analysis.

 Collaborates with the leadership on special projects related to audits, reporting, and

regulatory compliance.  Maintains accurate records and documentation for all regulatory, audit, and compliancerelated activities.

 Other duties as assigned.

Qualifications

Education and Experience

Bachelor’s degree in Healthcare Administration, Business

Administration, Public Health, Data Science, or related field; 3-4 years

of experience in the healthcare or managed care, with a focus on

grievance and appeals, compliance, or regulatory reporting preferred.

Experience with Medi-Cal, Medicare, DHCS, DMHC, NCQA, CMS,

or other regulatory healthcare environment preferred. An equivalent

combination of education and experience may be considered. Special Skills, Licenses and Certifications

Working knowledge of Medi-Cal, CMS, DHCS and/or NCQA

regulations and standards. Highly proficient in applicable business

software applications including PC usage, Microsoft Word,

PowerPoint, Excel, and typing speed of 40 wpm. Valid California

Driver's License and proof of current automobile insurance compliant

with Partnership’s policies are required to operate a vehicle and travel

for company business. Performance Based Competencies

Excellent oral and written communication skills. Strong analytical and

problem-solving skills with the ability to interpret data and trends.

Excellent organizational skills with the ability to prioritize

assignments, maintain effective filing systems, and meet deadlines.

Ability to work under minimal supervision and exercise independent

judgment. Diplomacy and tact in handling sensitive information

regarding personnel affairs as required. Ability to interact with

executives and vendors effectively, handling all assignments with

efficiency. Must be able to handle multiple tasks and meet deadlines.

Excellent judgment. Ability to work within an interdisciplinary

structure and function independently in a fast-paced environment while

managing multiple priorities and deadlines. Strong organizational skills

required. Work Environment And Physical Demands

Ability to use a computer keyboard. Ability to prioritize workload and

initiate action to acquire needed information from professionals by

phone. Ability to function effectively with frequent interruptions and

direction from multiple team members. More than 70% of work time is

spent in front of a computer monitor. Must be able to lift, move, or

carry objects of varying size, weighing up to 10 lbs. Some travel

required (up to 15%) including occasional overnight. All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures, as they may from time to time be

updated. HIRING RANGE:

$96,970.04 - $121,212.56 IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and

the requirements and conditions listed in this job description are representative only and not

exhaustive or definitive of the tasks that an employee may be required to perform. The employer

reserves the right to revise this job description at any time and to require employees to perform

other tasks as circumstances or conditions of its business, competitive considerations, or work

environment change.