Healthcare Compliance Analyst — PIP & Auto Regulations

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

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.