Analyst, Healthcare Compliance
Microsoft 365
Salary
💰 $104,300 - $213,650 per year
Job Level
Lead
About the role
- Oversee and enhance the company’s compliance program to ensure adherence with federal and state regulations, accreditation standards, and client contractual relationships.
- Lead the planning and execution of client and regulatory audits, manage audit responses, and ensure corrective actions are tracked to completion.
- Serve as the primary liaison for all client, regulatory, and accreditation audits (e.g., CMS, state Medicaid agencies, dental or vision plan clients).
- Oversee the coordination, preparation, and timely submission of audit deliverables and lead on-site or virtual audit activities.
- Track and monitor audit findings, corrective action plans (CAPs), and deadlines to resolution; collect and maintain documentation and evidence supporting completion of CAPs.
- Partner with internal stakeholders (claims, provider relations, operations, IT, etc.) to proactively identify and mitigate compliance risks.
- Investigate potential compliance violations, including internal complaints or regulatory inquiries, and represent the company in interactions with regulatory agencies.
- Lead corrections-focused compliance initiatives, provide direction, and mentor compliance team members.
Requirements
- Bachelor’s degree in business, healthcare administration, law or related field.
- 7+ years of progressive compliance, regulatory, or healthcare/insurance experience, including leading audits or corrective action initiatives.
- Strong knowledge of federal and state health insurance regulation, including Medicaid/Medicare, HIPAA, and state insurance laws.
- Maintain internet service: 50 Mbps download and 10 Mbps upload while hardwired and not on a VPN.
- Preferred: Advanced degree (e.g. MBA, MPH).
- Preferred: 3+ years in a leadership role (managing audits, corrective actions, or compliance teams).
- Preferred: Certified in Healthcare Compliance (CHC), Certified Compliance & Ethics Professional (CCEP), or equivalent.
