System Perform & Compliance Analyst

Who we are

About the Role

Responsible for developing, analyzing, monitoring performance systems and data to ensure provider network compliance with state and federal regulatory deliverables. This role includes ownership of project management processes for provider network monitoring, quality reporting and continuous process improvement.

To be successful in this role, you:

• Have a bachelor’s degree in a related field or an equivalent combination of education and highly relevant experience, required.
• Have two (2) years contract administration database experience, required.
• Have a minimum of three (3) years of experience in managed care contracting, health plan administration, or other comparable experience providing incumbent the skills necessary for the position
• Have two (2) years of project management experience, preferred.

Essential functions and Roles and Responsibilities:

• Develops and maintains processes to track and manage network regulatory deliverables, resolving issues to ensure accuracy of narratives and data submissions.
• Facilitates and supports teams to develop provider network regulatory narratives and coordinate annual audit deliverables
• Researches, analyzes, and tracks HCA provider network regulatory requirements relevant to the subdivision to provide subject matter expertise
• Builds internal reports and dashboards for subdivision to help support planning and strategy for network regulatory deliverables
• Develops and maintains performance monitoring across provider network systems to assess, analyze and monitor compliance strategies across provider contracting and network compliance departments for leadership reporting.
• Collaborates on contracting provider data gaps to ensure reliability, completeness, and consistency.
• Generates reporting and summarizes data from contract system, while analyzing and interpreting the data to produce summaries for stakeholders.
• Organizes plans for improving departmental system processes and performance in alignment with strategic network goals.
• Interfaces with provider contracting and network compliance departments and teams to initiate, develop, execute projects, and process improvement initiatives.
• Participates in cross-training with department analysts.
• Facilitates meetings, develops agendas, task management and guidance of meetings, related to provider network regulatory partner audits.
• Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

Knowledge, Skills, and Abilities:

• Effective communication skills, both verbal and written.
• Knowledge of Centers for Medicare & Medicaid Services (CMS), Healthcare Authority (HCA), Office of the Insurance Commissioner (OIC) Washington State managed care network regulatory requirements.
• Skills in data management accuracy, QA processes and ability to work with multiple and complex data sets.
• Ability to collect, organize, analyze, and disseminate significant amounts of information with diligence and accuracy.
• Ability to independently identify and analyze trends and initiate pro-active interventions.
• Effective organizational and time management skills.
• In-depth knowledge of Medicare, Medicaid, WA Health Insurance Marketplace products and managed care operations.

Note: If you think you do not qualify, please reconsider. Studies have shown that women and people of color are less likely to apply to jobs unless they feel they meet every qualification. However, everyone brings different strengths to the table for a job, and people can be successful in a role in a variety of ways. If you are excited about this job but your experience doesn’t perfectly check every box in the job description, we encourage you to apply anyway. 

As part of our hiring process, the following criteria must be met:

• Complete and successfully pass a criminal background check.

Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant’s criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.

• Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
• Vaccination requirement (CHPW offers a process for medical or religious exemptions)
• Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

Compensation and Benefits:

The position is FLSA Exempt and is not eligible for overtime and has a 10% annual incentive target based on company, department, and individual performance goals. The base pay actually offered will take into account internal equity and also may vary depending on the candidate’s job-related knowledge, skills, and experience among other factors. 

CHPW offers the following benefits for Full and Part-time employees and their dependents: 

•  Medical, Prescription, Dental, and Vision
•  Telehealth app
•  Flexible Spending Accounts, Health Savings Accounts
•  Basic Life AD&D, Short and Long-Term Disability
•  Voluntary Life, Critical Care, and Long-Term Care Insurance
•  401(k) Retirement and generous employer match
•  Employee Assistance Program and Mental Fitness app
•  Financial Coaching, Identity Theft Protection
•  Time off including PTO accrual starting at 17 days per year
•  40 hours Community Service volunteer time
•  10 standard holidays, 2 floating holidays
•  Compassion time off, jury duty

Sensory/Physical/Mental Requirements:

Sensory*:

• Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

Physical*:

• Extended periods of sitting, computer use, talking, and possibly standing
• Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion

Mental:

• Must have the ability to learn and prioritize multiple tasks within the scope and guidelines of the position and its applicable licensure requirements, many requiring extremely complex cognitive capabilities. Must be able to manage conflict, communicate effectively and meet time-sensitive deadlines.

Work Environment:

Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.

*Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

*The above is intended to describe the general content of and the requirements for satisfactory performance in this position. It is not to be construed as an exhaustive statement of the duties, responsibilities, or requirements of this position. Job descriptions may be updated or changed to reflect business needs.