Compliance Analyst

Job Type
Full-time

Description

Join Our Team as a Compliance Analyst!

The Compliance Analyst position reports to the Director of Compliance and functions in one or two industry arenas – 1) basic workers’ compensation fee schedules or 2) multiple state Personal Injury Protection (PIP/Auto) regulations, both focused on researching legislative rules for professional, hospital, and pharmacy providers in order to write requirements for the IT Development Team to implement within Prime Health’s bill review software .

What You'll Do

- Independently studies and interprets state or federal regulations for use in multiple product lines
- Manages and maintains rules in the PHS proprietary bill review software for multiple jurisdictions in multiple lines of business
- Collaborates with peers and other team members to elicit requirements, understand success factors and build out business requirements for PHS bill review products
- Performs unit and acceptance testing as necessary
- Work with the Development team to share understanding of business needs and ensure right outcomes
- Works with State Reporting team to ensure all state reporting requirements are met
- Performs other duties as assigned

Requirements

What We're Looking For

- Bachelor's Degree in health care administration, business, related field of study, or 4 years of direct experience in healthcare is required
- Understanding of Auto/PIP both first- and third-party claims administration is required to work Auto
- Demonstrated proficiency in Microsoft Office Suite (Excel, PowerPoint, Word)
- 2+ years of relevant work experience in a physician practice, hospital, ancillary provider, health insurance company, or integrated delivery system is preferred
- Knowledge of ICD-10CM, CPT4, Revenue Codes, DRGs, base rates, HCPCS coding and related governmental guidelines and provider reimbursement methodologies is preferred
- Knowledge of state jurisdictional regulations and rules for multiple lines of business, auto and workers compensation is strongly preferred

Competencies

- Excellent planning, communication, documentation, and organizational skills
- Advanced mathematical, analytical, and problem-solving skills
- Ability to interpret and summarize results of various analyses in a timely and meaningful way
- Ability to work cooperatively with multidisciplinary teams and/or independently

Why You'll Love Working at PHS

- Medical Insurance (high-deductible plan with HSA)
- Dental and Vision Insurance
- Company-paid short-term & long-term disability
- Company-paid group term life insurance
- Generous PTO Policy
- Employee recognition programs
- Corporate office amenities
- Frequent employee events

Who We are

Prime Health Services (PHS) is a national medical cost containment company specializing in customized PPO network solutions. Since 2001, we’ve partnered with insurance carriers, TPAs, self-insured groups, and government entities to deliver high-quality healthcare access at discounted rates. Our technology-driven approach allows us to provide fast, flexible, and dependable service to our clients while supporting a collaborative, employee-focused workplace.