Remote Healthcare Regulatory Compliance Analyst

International Council for Veterinary Assessment; Modesto (CA); Hybrid; USD 85,000 - 110,000; Full time

Benefits offered by this job

Medical coverage

Wellness program

Dental and vision

PTO and holidays

CalPERS retirement

FSAs

Life insurance

Disability

EAP

Tuition reimbursement

Remote work allowed

Job summary

Health Plan of San Joaquin seeks a Compliance Data Analyst to coordinate, research, and audit key compliance matters under supervision. You will support contract renewals, assess regulatory requirements, and maintain the compliance program.

The role requires strong analytical skills, knowledge of federal and state regulations, and the ability to communicate complex information clearly. Remote work is possible within California with travel as needed.

Qualifications

• In-depth knowledge of federal and state regulations and standards, including False Claims Act.
• Knowledge of managed care health plan functions and interactions as they relate to compliance.
• Knowledge of contracting regulations and best practices.
• Basic knowledge of ICD-10 and CPT coding and medical terminology, and industry standard payment practices.
• In depth knowledge of audit, control and monitoring processes, and the ability to effectively implement and maintain them.
• Strong analytical skills, including the ability to perform routine analysis and provide recommendations.

Responsibilities

• Supports development and renewal of state contracts and amendments, including coordination and revisions.
• Conducts risk assessments of business practices and mitigation plans.
• Researches contractual and regulatory requirements for health plans and vendors.
• Maintains the compliance audit program with schedules, standards and reports.
• Coordinates internal and external audits and identifies corrective actions.
• Guides stakeholders to ensure understanding of regulatory requirements and policies.
• Leads compilation and tracking of deliverables and ensures timely approvals.

Skills

Regulatory knowledge

Contracting regulations

Data analysis

Audit & monitoring

Analytical skills

English communication

Leadership

Time management

Project management

Interpersonal skills

Presentations

Microsoft Office

Education

Bachelor's Degree

3+ years related experience

Tools

Tableau

Excel

PowerPoint

Visio

Project

Job description

Health Plan of San Joaquin seeks a Compliance Data Analyst to coordinate, research, and audit key compliance matters under supervision. You will support contract renewals, assess regulatory requirements, and maintain the compliance program.

The role requires strong analytical skills, knowledge of federal and state regulations, and the ability to communicate complex information clearly. Remote work is possible within California with travel as needed.