Health Plan Compliance & Analytics Specialist

Ultimate Staffing; Modesto (CA); On-site; USD 33,000 - 34,000; Full time

Job summary

Ultimate Staffing Services is seeking a Health Plan Specialist in California to support health plan operations through data analysis, compliance, and documentation updates to meet regulatory requirements. This onsite role involves collaborating with CMS, DHCS, and cross-functional teams to ensure accurate reporting and adherence to policies.

Ideal candidates will have at least two years of experience in claims processing, contracting, and compliance, with strong Excel and MS Office skills.

Qualifications

• Two years of experience in claims processing, contracting, compliance, or related fields.
• CMS and HPMS IT familiarity preferred.
• Associate degree in business or healthcare administration or equivalent work experience.

Responsibilities

• Assist in CMS and DHCS compliance efforts and contract adherence.
• Prepare Medicare/Medicaid cost reports and related documentation.
• Manage inquiries to CMS and DHCS with timely responses.
• Analyze data to support decision making and trends.
• Prepare reports on Medicare and MediCal reporting and reimbursement.
• Support closing processes for Medicare and MediCal payments.
• Develop and maintain SOPs to comply with regulations.
• Ensure marketing materials comply with CMS regulations.
• Coordinate with geriatric patients including cognitive decline when needed.
• Submit regulatory reports to CMS and HPMS as required.

Skills

Analytical skills

Team collaboration

Education

Associate degree in business administration or healthcare administration

High School Diploma or equivalent

Tools

Excel

MS Office

Relational database modeling

Job description

Ultimate Staffing Services is seeking a Health Plan Specialist in California to support health plan operations through data analysis, compliance, and documentation updates to meet regulatory requirements. This onsite role involves collaborating with CMS, DHCS, and cross-functional teams to ensure accurate reporting and adherence to policies.

Ideal candidates will have at least two years of experience in claims processing, contracting, and compliance, with strong Excel and MS Office skills.