Compliance Analyst, Healthcare

Responsibilities

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc.

(UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

The Compliance Analyst provides support to the organization to execute key initiatives for the effectiveness of the Compliance Program for health plan products, including Medicare Parts C and D, large- and small-group health plans, third-party administration, and other commercial health plan products. The Compliance Analyst captures and analyzes data used to detect trends that may indicate systemic risks to the organization requiring further review, assessment, root cause analysis, or follow-up.

The Compliance Analyst will be responsible for monitoring the organization’s compliance with state and federal regulations. The Analysts will perform internal audits for the organization, manage regulatory communication, and facilitate engagement with external and internal stakeholders. The Compliance Analyst will support the Compliance Program to ensure compliance with Federal and State laws and regulations contract provisions, accreditation standards, and internal policies and procedures.

This position reports to the Manager of Compliance & Risk.

• Ensures Completion of Compliance Training by Prominence Health Plan Employees
• Ensures Completion of Compliance Training by Agents / Brokers
• Manages and Distributes HPMS and Agency Communications
• Authors Operational Audit Reports
• Authors and Facilitates Implementation of Operational Corrective Action Plans
• Performs Operational Audits
• Maintains Masterfile of Operational Risk Areas
• Performs / Facilitates External Compliance Audits
• Performs / Facilitates External Financial Audits (1 / 3 Financial, Bid Audit, Program Audit,
• Performs / Facilitates OIG / GSA Exclusion Screening (Prominence Health Plan Staff-FT / PT, Volunteers, Interns, Board Members, Providers)
• Operational Incident Management Resolution
• Performs / Facilitates Operational Corrective Action Plan Resolution and Monitoring
• Performs Operational Risk Assessment
• Performs Compliance Program Effectiveness Risk Assessment
• Coordinates Compliance and Department Meetings

• Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries!
  · More information is available on our Benefits Guest Website :

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory car

Qualifications and Requirements:

• Bachelor’s degree or equivalent work experience.
• Minimum two years’ experience in health insurance or health care compliance; experience with managed care organizations and Medicare Advantage preferred.
• Experience with State and Federal laws, regulations, policies and practices for the administration of Medicare Advantage, Prescription…