Compliance Analyst - San Jose, United States - Santa Clara Family Health Plan

Description

Compliance Analyst

Salary Range: $80,428 - $120,642
The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change.

FLSA Status:Exempt
Department:Compliance
Reports To:Manager, Compliance (Medi-Cal/Medicare)

Employee Unit: Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521

GENERAL DESCRIPTION OF POSITION

The Compliance Analyst researches, plans, implements, and monitors a broad portfolio of compliance programs and initiatives to enable organizational compliance with all applicable Federal, state, and local regulations/laws. On an on-going basis, researches and interprets regulations and laws to establish compliance standards, and may develop and/or deliver training and/or communications relative to new standards. May be responsible for project management relative to new compliance initiatives, products, or annual processes

ESSENTIAL DUTIES AND RESPONSIBILITIES

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below.

1. Implement, support and enforce SCFHP's Privacy Program; assist in updates and revisions to the Privacy Program as needed or required by law to ensure SCFHP's compliance with state, federal and international privacy laws; implement, support, and enforce best practices to protect the privacy of members' protected health information (PHI).
2. Build strong relationships and collaborate with business units to promote the Privacy Program and encourage privacy compliance at all levels of the organization
3. Assist as requested in the timely creation, review, revision and updates to privacy policies, desk level procedures, resource guides, job aides and other educational tools
4. Provide guidance and instruction to workforce members on privacy policies and procedures, privacy-related questions, and subject matter expertise as needed for each unique, individual situation.
5. Act as a liaison with regulatory enforcement agencies; cooperate and participate as required by technical assistance letters, investigations, compliance reviews, audits and other reviews made by regulatory agencies, including CMS, OCR, DMHC, and DHCS.
6. Provides project management, coordination, and analytical support for compliance projects. Provides consultation on internal and external requirements. Evaluates regulatory requirements and potential operational impacts.
7. Assists in the identification of compliance program needs, and develops strategies, plans, and documentation for programs and related initiatives.
8. Supports the Manager, Compliance (Medi-Cal/Medicare) by designing, documenting and implementing process improvement initiatives within the department.
9. Supports and when directed, leads the Compliance Work Group and other cross-functional work groups.
10. Assists in leading the development and maintenance of health plan FWA program capabilities and offerings.
11. Supports compliance audits, risk assessments and ongoing compliance monitoring activities, including the coordination of data requests.
12. Assists in identifying, developing, implementing and maintaining compliance policies and procedures and department documentation.
13. Preparing and submitting timely and accurate regulatory filings (DMHC, DHCS, provider network contracts, licensing renewals, etc.), regulatory reports, and compliance attestations.
14. Perform other related duties as required or assigned.

REQUIREMENTS - Required (R) Desired (D)

The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

1. Bachelor's Degree in Business, Healthcare Administration or a related field or equivalent experience, training or coursework. (R)
2. Minimum 3 years progressively responsible compliance experience in a healthcare or managed care environment. A Master's Degree may be substituted for one year of required experience. (R)
3. Knowledge of health care compliance policies, practices and systems. (R)
4. Ability to analyze and interpret data to identify trends. (R)
5. Ability to maintain detailed and accurate records; follow oral and written directions; prepare written agendas, transcribe minutes, and develop reports. (R)
6. Ability to conduct all necessary research, root analysis and trends to accurately identify complex issues. (R)
7. Ability to consistently meet compliance accuracy and timeline requirements according to regulatory requirements. (R)
8. The ability to form positive, professional relationships with regulators, providers, and stakeholders. (R)
9. Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, Access, and PowerPoint. (R)
10. Ability to use keyboard with moderate speed and a high level of accuracy. (R)
11. Excellent communication skills including the ability to express oneself clearly and concisely when interacting with SCFHP internal and external stakeholders over the telephone, in person or in writing and the ability to remain calm and de-escalate tense situations. (R)
12. Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R)
13. Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R)
14. Ability to maintain confidentiality. (R)
15. Ability to comply with all SCFHP policies and procedures. (R)
16. Ability to perform the job safely and with respect to others, to property and to individual safety. (R)

WORKING CONDITIONS

Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications.

PHYSICAL REQUIREMENTS

Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:

1. Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R)
2. Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R)
3. Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R)
4. Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R)
5. Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R)
6. Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R)

ENVIRONMENTAL CONDITIONS

General office conditions. May be exposed to moderate noise levels.

EOE