compliance analyst

Job Summary:

The Compliance Analyst reports to Vivant's Compliance Sr. Manager and plays a key role in supporting and strengthening Vivant's Compliance Program and department operations. The Compliance Analyst is essential to mitigating risks and fostering a culture of compliance and ethical behavior across the organization. The Analyst collaborates with operational departments to ensure adherence to Vivant's internal policies and procedures, health plan contracts as well as applicable federal, state and local rules and regulations governing Vivant's business. 

Responsibilities:

The Compliance Analyst is responsible for monitoring compliance activities, conducting audits, analyzing data, and assisting with the development and implementation of Compliance Program, by performing the following functions:

• Health Plan Audits: serve as the primary liaison between health plans and internal business units during delegation oversight audits. Communicate audit timelines, requirements, and expectations to all relevant stakeholders, maintain audit calendars, and ensure all deadlines are met.
• Health Plan Reports: track regulatory reports required by health plans and ensure their timely submission. Assist with quality control of requested reports when appropriate.
• Other Health Plan Communications and Requests: review, summarize, track and distribute communications received from health plans to the appropriate internal business units. Coordinate with internal teams to ensure timely responses to health plan inquiries and requirements.
• Support Business Units: track inquiries received from internal business units, research responses as needed, or escalate to Compliance leadership for guidance. Ensure timely and accurate communication back to the requesting business units.
• Regulatory Updates: stay current with healthcare laws and regulations (e.g., HIPAA, CMS, DHCS, and DMHC) and communicate updates to business units.
• Compliance Committee: support the operations of the Compliance Committee by preparing meeting agendas and materials, recording minutes, and following up on assigned action items.
• Policies and Procedures: maintain and track Vivant's centralized repository of policies and procedures. Support the review and revision of Compliance Department policies and procedures to ensure accuracy and regulatory alignment. 
• Incident Investigation: may track and document PHI privacy and other compliance-related issues, document findings, and work with Compliance leadership to monitor that corrective action has been implemented.
• Internal Monitoring: may conduct internal audits and monitoring activities, issue audit findings and corrective action requests, and present audit results to the Compliance Committee.
• Training and Education: may deliver Compliance training programs for staff to ensure understanding of regulatory requirements.
• Performs related duties consistent with the scope and intent of the position.
• Regular attendance.
• Travel as required.

Other Functions

• Enforces Company policies and safety procedures.
• Regularly updates job knowledge by participating in educational opportunities, reading professional publications, maintaining professional networks, and participating in professional organizations.
• Maintain IPA, Health Plan compliance standards.

Travel

• The incumbent may travel up to 5% of the time.
Qualifications


Competencies

• Minimum two (2) years of full-time experience in healthcare is required. Managed Care experience is preferred.
• Minimum two (2) years of healthcare compliance experience is preferred.
• Certification in Health Care Compliance (CHC) is preferred.
• Strong Microsoft Excel experience, including developing formulas and creating dashboards, is required.
• Possession of strong communication (both oral and written) and leadership skills, including diplomacy, independence, integrity, and trustworthiness, while commanding respect of the senior management and executive team, governing body and other colleagues.
• Consistent exercise of sound judgment.
• Proactive and effective advanced problem solver.
• Excellent attention to detail, multi-tasking, time management, project management, and organization skills to meet deadlines.
• Excellent judgment, sound discretion, and strict maintenance of confidentiality.
• Strong understanding of IPA and medical clinic operations, compliance, and quality programs.
• Ability to independently develop and draft policies and procedures.
• Analytical reasoning and technical and/or analytic skills are required.
• Excellent active listening and critical thinking skills.
• Consistent exercise of sound judgment.
• Proactive and effective problem solver.
• Strive to work collaboratively with others and be able to develop partnerships and good working relationships, with an open management style.
• Ability to develop and present training materials to an audience.
• Demonstrated excellence in project management and organization.
• Ability to provide and receive constructive job and/or industry related feedback.
• Ability to maintain confidentiality and appropriately share information on a need-to-know basis.
• Ability to exercise sound discretion and strict maintenance of confidentiality of all confidential and sensitive communications and information.
• Excellent attention to detail and ability to document information.
• Demonstrate commitment to the organization's mission.

Education and Experience

• High School Diploma or GED minimum requirement.
• BA/BS degree or equivalent experience in related field is required.
• MBA, MPH, MHA, or related field is preferred.