Compliance Analyst

Prime Health Services; Franklin (TN); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Disability Insurance

Life Insurance

Paid Time Off

Employee events

Job summary

Prime Health Services is seeking a Compliance Analyst to interpret state and federal regulations for bill review software across workers’ compensation and Auto/PIP lines. You will translate regulatory findings into actionable IT requirements and coordinate with the Development team.

Reporting to the Director of Compliance, you’ll review state rules, test business outputs, and collaborate with cross-functional teams to ensure accurate provider reimbursements and regulatory adherence.

Qualifications

• Bachelor’s degree or 4 years of direct healthcare experience is required.
• Understanding of Auto/PIP claims administration is required.
• Proficiency in Microsoft Office Suite (Excel, PowerPoint, Word)
• 2+ years of relevant work experience in healthcare settings preferred.
• Knowledge of ICD-10CM, CPT4, Revenue Codes, DRGs, base rates, HCPCS coding and related guidelines preferred.
• Knowledge of state jurisdictional regulations for auto and workers’ compensation preferred.

Responsibilities

• Independently studies and interprets regulations for multiple product lines.
• Maintains rules in the bill review software for multiple jurisdictions.
• Collaborates to elicit requirements and build out business requirements for bill review products.
• Performs unit and acceptance testing as necessary.
• Liaises with Development to ensure business needs are met.
• Ensures state reporting requirements are met.

Skills

Analytical skills

Problem-solving

Communication skills

Documentation

Organizational skills

Microsoft Office

Education

Bachelor’s degree in health care administration, business, or related field

4 years healthcare experience

Tools

Microsoft Office Suite

Job 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.