PACE Health Plan Compliance Analyst

HCA Healthcare; Asheville (NC); On-site; USD 65,000 - 85,000; Full time

Job summary

Join HCA Healthcare as a PACE Health Plan Compliance Analyst in Asheville, NC. This entry-level position focuses on vendor coordination, ensuring compliance, and analyzing performance data within the healthcare sector. We offer robust benefits including comprehensive health coverage, a supportive work environment, and opportunities for career advancement.

Benefits

401(k) Plan with matching

Tuition assistance

Comprehensive medical coverage

Flexible spending accounts

Employee Stock Purchase Plan

Family support benefits

Free counseling services

Paid time off

Qualifications

• Bachelor’s degree required, Master’s preferred.
• Minimum 1 year experience in administrative roles.
• Healthcare experience preferred, claims processing experience beneficial.

Responsibilities

• Coordinates vendor contracting services for the PACE program.
• Prepares statistical reports and ensures compliance.
• Supports audits and manages data analysis for health plan functions.

Skills

Verbal communication

Written communication

Organizational skills

Detail-oriented

Document management

Education

Bachelor’s in Business Administration

Related field

Master’s Degree (preferred)

Job description

PACE Health Plan Claims Compliance Analyst

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PACE Health Plan Claims Compliance Analyst

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Description

Introduction

Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized. Submit your application for the opportunity below: PACE Health Plan Compliance Analyst at CarePartners

Benefits

CarePartners, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
• Free counseling services and resources for emotional, physical and financial wellbeing
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock
• Family support through fertility and family building benefits with Progyny and adoption assistance.
• Referral services for child, elder and pet care, home and auto repair, event planning and more
• Consumer discounts through Abenity and Consumer Discounts
• Retirement readiness, rollover assistance services and preferred banking partnerships
• Education assistance (tuition, student loan, certification support, dependent scholarships)
• Colleague recognition program
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.
  
  

Learn More About Employee Benefits

Note: Eligibility for benefits may vary by location.

We are seeking a PACE Health Plan Compliance Analyst for our team to ensure that we continue to provide all patients with high quality, efficient care. Did you get into our industry for these reasons? We are an amazing team that works hard to support each other and are seeking a phenomenal addition like you who feels patient care is as meaningful as we do. We want you to apply!

Job Summary And Qualifications

Under general supervision, oversees coordination of outside vendor contracting services with the provider and supplier network for the CarePartners PACE program. Collects, analyzes, and prepares performance improvement data, reports, and other statistical data. Develops, maintains, and ensures quality control of databases and assists in development and implementation of measurement systems. Maintains compliance and provides support of health plan business functions relating to contracted business partners. Provides full range of administrative and meeting support.

Essential Accountabilities

• Coordinates outside vendor contracting services for the CarePartners PACE program
• Works with Quality and Compliance Manager to coordinate quality oversight of vendors and contracted providers including Title III, CAP-DA, PACE and HomeCare regulations
• Prepares statistical and narrative reports and recommendations and participates in interpretation and analysis of data, as assigned
• Works with Health Plan Manager and Third-Party Administrator to maintain compliance with the claims processing and authorization processes
• Works with TPA, Pharmacy Benefits Manager, and Health Plan Enrollment & Outreach Specialist to ensure efficient enrollment and disenrollment of new and outgoing program participants
• Supports Quality and Compliance Manager and Program Director with preparation for audit compliance for CMS (PACE), JCAHO (Private Duty), Title III and CAP-DA
• Performs other duties as required or requested
  
  

About the position:

• Onsite position in Asheville, NC
• Full-time, 40-hours a week, flexible 7am-4pm or 8am-5pm schedule
  
  

What qualifications you will need:

Required Education: Bachelor’s in Business Administration or Health Care Administration or related field

Preferred Education: Master’s Degree

Required License: Current driver’s license

Preferred License: Six Sigma, CPHRM, HCQM

Required Experience: Minimum of one year working experience in administrative role with vendors and data analysis

Preferred Experience: Minimum of one year working experience in healthcare. Experience working in hospital environments, physician practices, billing groups, or experience in the insurance or government payor side of the billing cycle. Claims processing experience preferred.

Needed Knowledge, Skills, & Abilities:

• Exceptional verbal and written communication skills and organizational skills.
• Communicates and presents information in a concise and positive manner to positively promote CarePartners.
• Establishes priorities, coordinates work activities and works independently.
• Must be detail oriented and have excellent document management skills.
• Ability to review and understand legal and technical documents, contracts, etc.
  
  

CarePartners Health Services is a healthcare organization serving western North Carolina and offering a full continuum of post-acute care. Located in Asheville, North Carolina, CarePartners provides compassionate post-acute care, including rehabilitation, home health, adult care, hospice and palliative care. CarePartners also offers a full acute care rehabilitation hospital. With more than 1,200 colleagues and 400 volunteers, CarePartners Health Services is dedicated to helping people of western North Carolina live full and productive lives, despite illness, injury, disability or issues related to aging. CarePartners Health Services is a member of Mission Health, an operating division of HCA Healthcare.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"There is so much good to do in the world and so many different ways to do it."- Dr. Thomas Frist, Sr.

HCA Healthcare Co-Founder

If you find this opportunity compelling, we encourage you to apply for our PACE Health Plan Compliance Analyst opening. We promptly review all applications. Highly qualified candidates will be directly contacted by a member of our team. We are interviewing apply today!

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Administrative and Health Care Provider

• Industries

  Hospitals and Health Care

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