Compliance Analyst

Prime Health Services; Franklin (TN); On-site; USD 70,000 - 85,000; Full time

Benefits offered by this job

Medical Insurance

Dental & Vision Insurance

Disability Insurance

Life Insurance

PTO

Recognition Programs

Office amenities

Employee events

Job summary

Prime Health Services in Franklin, TN is seeking a Compliance Analyst to interpret state and federal health care regulations and translate them into actionable IT requirements for our bill review software.

You will collaborate with the Director of Compliance, the Development Team, and State Reporting to ensure accurate rules, thorough testing, and compliant implementation across multiple jurisdictions.

This role offers growth in a fast-paced, mission-driven environment with comprehensive benefits.

Qualifications

• Bachelor's Degree in health care administration, business, related field of study, or 4 years of direct healthcare experience is required
• Understanding of Auto/PIP both first- and third-party claims administration is required to work Auto
• Proficiency in Microsoft Office Suite (Excel, PowerPoint, Word) preferred
• 2+ years of relevant work experience in healthcare settings is preferred
• Knowledge of ICD-10CM, CPT4, Revenue Codes, DRGs, base rates, HCPCS coding and provider reimbursement guidelines is preferred
• Knowledge of state jurisdictional regulations for auto and workers' compensation is strongly preferred

Responsibilities

• Independently studies and interprets state or federal regulations for use in multiple product lines
• Manages and maintains rules in the PHS bill review software for multiple jurisdictions in multiple lines of business
• Collaborates with peers and other team members to elicit requirements and build out business requirements for 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

Skills

Regulatory interpretation

Analytical thinking

Effective communication

Project management

Education

Bachelor's degree in health care administration, business, or related field or 4 years healthcare experience

Tools

Excel

PowerPoint

Word

Job description

Job Type
Full-time

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.