What are the responsibilities and job description for the Senior Compliance Analyst, Operations position at Health Plan of San Joaquin/Mountain Valley Health Plan?
Job Title: Compliance Analyst, Senior (Operations)
Vision: Continuously improve the health of our community.
Mission: We provide healthcare value and advance wellness through community partnerships.
Job Summary:
The Compliance Analyst, Senior (Operations) provides decision support and insightful guidance to ensure regulatory adherence and operational efficiency. This role requires a high degree of discretion and independent judgment, with a focus on improving the health of our community.
Key Responsibilities:
- Lead Complex Compliance Programs: Develop and implement compliance strategies to enhance regulatory adherence and operational efficiency.
- Conduct Risk Assessments: Identify areas of exposure and develop mitigation strategies to address risks effectively.
- Research and Analysis: Conduct advanced research and analysis of contractual, regulatory, and legal requirements for HPSJ and its delegated vendors.
- Implement Enterprise-Wide Initiatives: Drive the implementation of key Compliance and enterprise-wide initiatives by coordinating efforts across departments.
- Provide Expert Guidance: Offer expert interpretation and training to internal and external stakeholders to promote understanding of and adherence to regulatory, contractual, and accrediting requirements.
- Assess Financial Impact: Evaluate the financial impact of compliance issues and provide actionable reports to inform leadership decisions.
- Create Compliance Reports: Develop, refine, and present routine and ad-hoc Compliance Reports offering actionable insights through clear written interpretation of analytical findings.
- Ensure Data Management: Enter and maintain information, documents, and records in compliance software and other systems adhering to organizational and regulatory standards.
- Develop Policies and Procedures: Create, update, and manage policies and procedures to ensure compliance with federal/state laws, regulations, and program standards.
- Support Team Members: Provide comprehensive support and serve as a backup for team members across various functions ensuring seamless continuity of compliance program management and oversight during absences or high-demand periods.
Requirements:
- Expert-Level Knowledge: Advanced knowledge of federal and state regulations and standards including the False Claims Act, Medi-Cal, Medicare, and DMHC/DHCS/CMS.
- Strong Writing Skills: Excellent writing skills with strong attention to detail.
- Analytical Skills: Highly developed analytical skills including data analysis, trend identification, and compliance recommendations.
- Leadership Skills: Strong leadership and influence skills with the ability to mentor junior compliance staff, drive organizational compliance culture, and lead cross-functional initiatives without formal authority.
- Project Management Skills: Project management skills including project lifecycle, scope definition, planning, monitoring, communication cycles, project team, and risk management.
- Communication Skills: Excellent oral and written communication skills with the ability to draft, refine, and present policies, reports, and compliance training materials clearly and persuasively to diverse audiences.
- Educational Requirements: Bachelor's degree in business administration, Healthcare Administration, Public Health, Law, Finance, or a related field, and at least three years of experience in compliance, regulatory, audit, risk management in healthcare, insurance, finance, or a highly regulated environment.
