Compliance Analyst: PIP/Auto Rules & Bill-Review Impact

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

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.