Audit and Compliance Analyst *Hybrid*
About the position Providence Health Plan is calling an Audit and Compliance Analyst who will handle various elements of program compliance, policy development, auditing, monitoring, and report development within the Health Care Services teams including Care Management and Utilization Management. The role involves working as a liaison for external delegated entities to provide operational support in addition to auditing and monitoring delegated functions. The analyst will collaborate with the Regulatory Compliance & Government Affairs department (RCGA) to evaluate state and federal regulations as they pertain to Health Care Services and the various lines of business. Additionally, the analyst will work closely with the Clinical Analytics and Information Systems teams to develop, review, and validate internal and external audit reports. The position also requires assisting teams with the review and interpretation of regulatory guidance and requirements as well as policy and procedure development. The analyst will provide monitoring and oversight of business partners and delegates to ensure compliance with all regulatory requirements, accreditation standards for the National Committee for Quality Assurance (NCQA), and meeting all client Service Level Agreements (SLA's). Responsibilities • Handle various elements of program compliance, policy development, auditing, monitoring, and report development within the Health Care Services teams. • Act as a liaison for external delegated entities to provide operational support and auditing. • Evaluate state and federal regulations as they pertain to Health Care Services. • Develop, review, and validate internal and external audit reports. • Assist teams with the review and interpretation of regulatory guidance and requirements. • Provide monitoring and oversight of business partners and delegates to ensure compliance with regulatory requirements and accreditation standards. Requirements • Bachelor's Degree in Business Administration, Healthcare Administration, or another related field of study, or a combination of equivalent education and experience. • 3+ years' experience working with administrative, policy, and/or operational aspects of managed care. • 3+ years' experience in project management. • 3+ years' experience in data analysis. • 3+ years' experience in procedure development. • 1+ years' experience in technical or operational policy and procedure writing as it relates to regulatory requirements and accreditation standards. • Experience with managed care regulatory compliance matters in one or more of the following lines of business: Medicare, Medicaid, Commercial. • Experience assessing program compliance and establishing auditing and monitoring protocols. Nice-to-haves • Experience with CMS and State Medicaid regulations and programs as they relate to Medical Management. Benefits • 401(k) Savings Plan with employer matching. • Health care benefits (medical, dental, vision). • Life insurance. • Disability insurance. • Paid parental leave. • Vacation and holiday time off. • Voluntary benefits. • Well-being resources. Apply tot his job