ACA Senior Compliance Analyst PCHP

Parkland Health; Dallas (TX); Hybride; USD 110 000 - 160 000; Plein temps

Résumé du poste

Parkland Health is seeking an experienced Health Plan Compliance Manager to oversee compliance policies and guidance for ACA/Marketplace requirements. This role focuses on regulatory filings, monitoring, and education across departments, with a hybrid work arrangement and standard daytime schedule.

Ideal candidates will have 5+ years in healthcare compliance, a CHC certification within two years, and strong communication and analytical skills to promote a robust compliance program across

Qualifications

• Bachelor’s degree in Healthcare Administration, Business Administration or related field.
• Master’s degree in Healthcare Administration, Business Administration or related field preferred.
• Five years of relevant experience as a healthcare compliance professional.
• Experience designing and implementing organizational reporting processes for compliance.

Responsabilités

• Regulatory and Compliance: Ensure compliance with ACA/Marketplace regulations and 45 CFR parts; prepare filings and submissions; attend regulatory meetings; develop committee agendas and minutes.
• Reporting and Monitoring: Maintain compliance logs; support risk assessments; track regulatory notices; create dashboards and reports for leadership.
• Training and Education: Develop and disseminate education; manage compliance training; create internal communications.
• Professional Accountability: Build cross-functional relationships; uphold integrity and confidentiality; adhere to policies; participate in meetings and town halls.
• Job Accountabilities: Identify process improvements; stay current with developments by attending seminars and professional activities; disseminate findings.

Connaissances

Verbal & written communication

Interpersonal skills

Analytical thinking

Time management

Detail-oriented

Microsoft Office

Learning new software

ACA knowledge

Regulatory compliance

Problem solving

Formation

Bachelor's in Healthcare Administration or related field

Master's in Healthcare Administration or related field

Equivalent education/experience

Outils

SERFF

CMS/Marketplace reporting systems

Description du poste

Special Note: Strong candidates will have experience with Affordable Care Act ACA-related regulations, compliance requirements, reporting, or administration rather than simply having general healthcare experience. Work schedule: Hybrid / Full-time Days; 8 a.m. until 4 p.m., Monday through Friday

PRIMARY PURPOSE

Responsible for the ongoing management of the Health Plan compliance policies, procedures and guidelines. This position supports the ongoing development, maintenance, review and assessment of PCHP’s compliance, evaluates changes in regulatory requirements and coordinates efforts to operationalize them across the Health Plan.

MINIMUM SPECIFICATIONS

• Education Bachelor’s degree in Healthcare Administration, Business Administration or related field.
• Master’s degree in Healthcare Administration, Business Administration or related field is preferred.
• Experience Five years of relevant professional experience as a healthcare compliance professional.
• Experience in designing and implementing organizational reporting processes and structures that enhance and encourage complete and accurate tracking, coordination and reporting of compliance activities and events.
• Equivalent Education and/or Experience Seven (7) years of experience in a comparable position working in commercial or Marketplace (ACA) health insurance, or with a health insurance issuer offering Qualified Health Plans, may be considered in lieu of a degree.
• Certification/Registration/Licensure HCCA Certified in Healthcare Compliance (CHC) required within two years from the date of entry into the position.
• Required Tests for Placement None.

Skills or Special Abilities

• Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines.
• Ability to communicate complex information in understandable terms.
• Strong interpersonal and conflict resolution skills with the ability to establish and maintain effective working relationships across and beyond the organization.
• Excellent analytical and problem-solving skills.
• Strong time management and organizational skills with the ability to manage multiple demands and respond to rapidly changing priorities.
• Ability to write clearly and succinctly with a high level of attention to detail.
• Proficient computer and Microsoft Office skills.
• Ability to learn new software programs.
• Knowledge of the Affordable Care Act (ACA), Federally-facilitated Marketplace and Qualified Health Plan (QHP) requirements, National Committee for Quality Assurance (NCQA), the Texas Insurance Code, and applicable federal regulations (45 CFR).

Responsibilities

Regulatory and Compliance

Ensures work is carried out in compliance with regulatory and/or accreditation standards as well as contractual requirements. Responsible for understanding and applying ACA/Marketplace regulations and requirements including 45 CFR Parts 153, 155, and 156, the Texas Insurance Code, TAC, and applicable CMS and Texas Department of Insurance (TDI) guidance. Prepares, coordinates, and tracks regulatory filings and submissions, including TDI form and rate filings (SERFF), QHP certification and recertification materials, and required CMS/Marketplace data submissions. Attends meetings hosted by regulatory agencies and tracks completion of compliance-related action items. Develop compliance committee agendas, presentations, and minutes.

Reporting and Monitorin g

Maintains log and reporting of internal monitoring and compliance risks. Assists with the creation and implementation of the compliance risk assessment, and compliance monitoring and auditing work plan. Responsible for the ongoing tracking and monitoring of Health Plan compliance using data analytics. Assists with regulatory reporting related to fraud, waste, and abuse activities. Develops appropriate compliance reports, including dashboards, tracking logs and summary reports that communicate the status of the compliance program to leadership. Assigns and tracks completion of regulatory notices, rule changes, and guidance issued by the Centers for Medicare & Medicaid Services (CMS) and the Texas Department of Insurance (TDI).

Training and Education

Assists in developing and disseminating topic-specific education to Health Plan personnel based on identified risks or changes in law or regulation. Manages compliance training program including identifying gaps in training curriculum and reporting. Assists in the development and creation of internal Compliance related communications/newsletter.

Professional Accountability

Builds and maintains strong collaborative working relationships across PCHP’s functional areas including legal, contracting, provider relations, member relations, utilization management, quality monitoring and information systems. Promotes and supports a culturally welcoming and inclusive work environment. Acts with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values. Adheres to organizational policies, procedures, and guidelines. Completes assigned training, self-appraisal, and annual health requirements timely. Adheres to hybrid work schedule requirements. Attends required meetings and town halls. Recognizes and communicates ethical and legal concerns through the established channels of communication. Demonstrates accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information. Maintains confidentiality at all times.

Job Accountabilities

Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of PCHP. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining c