Regulatory Reporting Analyst - Fairfield, United States - Partnership HealthPlan of California

Partnership HealthPlan of California Fairfield, United States

2 days ago

Description

Overview:

To develop and implement long-term quantitative analysis strategies to meet NCQA and DHCS
standards for reporting. To perform, and assist in the performance of, duties that ensure the
accuracy, completeness and truthfulness of enterprise wide regulatory reporting including all data,
information and documentation submitted to PHCs governing agencies. Works collaboratively
with all PHC department subject matter experts (SME) to implement new regulatory reporting
requirements or templates and assist in troubleshooting regulatory reporting issues. To develop
and implement strategies to meet NCQA standards for the oversight of delegate reporting.
Supports the plan-wide Privacy and Fraud, Waste and Abuse (FWA) program by preparing trend
analysis, forecasting reports and managing data collection in EthicsPoint.

Responsibilities:

Responsible for independently validating the accuracy of regulatory reports submitted to
the Regulatory Affairs and Compliance (RAC) unit by department SMEs or delegates to
ensure reporting is in conformance with the regulatory agencies reporting template and
contains the required attributes specified in reporting instructions prior to filing with PHCs
governing agencies.
Develops and maintains working knowledge of PHCs governing agencies reporting
requirements and NCQA standards for the oversight of delegation reporting to work with
key department SMEs to support compliance with all reporting requirements and NCQA
standards and assist in troubleshooting regulatory reporting issues.
Project/program involvement will include working with department SMEs to implement new
reporting requirements for new programs and benefits including DHCS Drug Medi-Cal and
CCS Whole Child Model.
Communicate regulatory reporting changes to existing regulatory reporting templates or
other reporting requirements to all department SMEs and the Delegation Oversight unit and
work with affected departments to implement changes.
Works closely with department SMEs and Delegation Oversight unit to resolve any
regulatory report quality issues.
Serves as primary contact for internal and external regulatory reporting related inquiries.
Maintain PHCs Regulatory Reporting Calendar, Master List Tracking Sheet and Data
Certification
Serves as an active contributor in data quality or analytic workgroups and assist in
developing data governance and data quality issue resolution, streamline reporting to
reduce unnecessary duplication; ensures consistent and accurate use of regulatory data
reporting.
Under the direction of the Regulatory Affairs Manager, works on analyzing and documenting
current processes to determine process needs that will improve the performance and/or
increase efficiency within the unit.
Assist in developing or updating RACs processes including policies and procedures,
desktop procedures, workflows, best practices and training materials.
Develop quantitative and trending reports for Privacy and FWA reported incidents via
EthicsPoint advanced analytic tools.
Enhance current tracking and trending mechanisms to consolidate into EthicsPoint.
Prepare and distribute standard daily, weekly, monthly and quarterly reports and present
Privacy and FWA statistic reports to the PTAS and FWA workgroups or Compliance
Committee as a backup for the Regulatory Affairs Manager.
Provide back up and support to Regulatory Affairs Specialist as required in Privacy and
FWA investigations, including creating randomized data sampling or other analysis
required.
Research complex regulatory related inquires, provide accurate and timely response
utilizing all applicable State and Federal regulations.
Supports compliance training program.
Supports internal and external audits
Participates in special projects and assignments as needed
Other duties as assigned.

Qualifications:

Education and Experience

Bachelors degree in relevant field; two three (2-3) years of experience
in the health care field, managed care experience preferred; must have
knowledge of regulatory related reporting requirements and Medi-Cal
regulations; experience with data analytics and forecasting trends
preferred; or equivalent combination of education and experience.

Special Skills, Licenses and Certifications

Highly proficient in applicable business software applications including
PC usage, Microsoft Word, PowerPoint, Excel, Visio, SharePoint, typing
speed 45 wpm. Valid California drivers license and proof of current
automobile insurance compliant with PHC policy are required to operate
a vehicle and travel for company business.

Performance Based Competencies

Excellent oral and written communications skills. Excellent organization
skills with ability to prioritize assignments, and maintain effective filing
systems. Ability to work under minimal supervision and exercise
excellent independent judgement. 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 work well under pressure,
handle multiple tasks and meet deadlines under short turnaround times
or tight timeframes.

Work Environment And Physical Demands

Ability to use a computer keyboard and other business machines. More
than 50% of work time is spent in front of a computer monitor. When
required, ability to move, carry, or lift objects of varying size, weighing
up to 35 lbs.

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 HealthPlans policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$ 79, $ 103,055.85

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.

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