Healthcare Compliance Analyst - PIP/Auto Regulations

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

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.