Compliance Analyst

Prime Health Services, Inc.; Franklin (TN); On-site; USD 55,000 - 85,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Disability Insurance

Life Insurance

PTO

Employee recognition

Office amenities

Employee events

Job summary

Prime Health Services, Inc. is seeking a Compliance Analyst to join our compliance team. You will research and translate state and federal regulations on workers’ compensation fee schedules and auto/PIP rules into actionable requirements for our IT bill review platform.

Reporting to the Director of Compliance, you will manage rule sets across jurisdictions, collaborate with IT and State Reporting, and participate in testing to ensure accurate implementations.

Qualifications

• Bachelor’s degree in health care administration or related field, or 4 years healthcare experience.
• Understanding of Auto/PIP first- and third-party claims administration.
• Proficiency in Microsoft Office Suite (Excel, PowerPoint, Word).
• 2+ years of relevant work experience in healthcare settings preferred.
• Knowledge of ICD-10-CM, CPT, HCPCS, DRGs, and provider reimbursement rules preferred.
• Knowledge of state regulations for multiple lines of business, auto and workers’ compensation preferred.

Responsibilities

• Study and interpret state/federal regulations for multiple product lines.
• Manage and maintain rules in PHS bill review software across jurisdictions.
• Collaborate with peers to elicit requirements and write business requirements for bill review products.
• Perform unit and acceptance testing as necessary.
• Work with the Development team to ensure outcomes meet business needs.
• Work with State Reporting team to ensure all state reporting requirements are met.
• Performs other duties as assigned.

Skills

Regulatory interpretation

Analytical thinking

Communication skills

Team collaboration

Education

Bachelor’s degree in health care administration or related field

Tools

Microsoft Office Suite (Excel, PowerPoint, Word)

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.